scholarly journals Femoral head penetration in Vitamin-E polyethylene liner versus conventional liners in total hip arthroplasty: systematic review and meta-analysis of randomised control trials

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 47
Author(s):  
Hany Elbardesy ◽  
Himanshu Yadav ◽  
Mohamed Rabea ◽  
Shane Guerin ◽  
James Harty
Keyword(s):  
Vitamin E ◽  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Systematic Reviews ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Polyethylene Liner ◽  
Head Penetration ◽  
Randomised Control Trials ◽  
Femoral Head Penetration

Background: Debate encompasses the use of Vitamin E Polyethylene or conventional Polyethylene liner in primary hip arthroplasty. Does the Inclusion of Vitamin E in PE give adequate protection from oxidation and maintains lower rates of wear? Patients and methods: We performed this study following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA) and the Cochrane Handbook for systematic reviews and meta-analysis. Studies were included from any region, written in any language. We had only the randomised control trials comparing the femoral head penetration between Vitamin-E diffused highly cross-linked polyethylene (VEPE) liner and conventional liners in primary total hip arthroplasty. Results: We included 10 studies in this meta-analysis. We conducted them using Review Manager V.5.0. We computed the risk ratio to measure the treatment effect, considering the heterogeneity. We used Random-effect models. VEPE had insignificant marginal advantages for FHP within three months post-operative. Additionally, VEPE showed significantly less FHP after two and five years. After one year, it showed significantly less FHP with the VEPE group versus the UHMWPE cohort and a non-significant difference between the VEPE and XLPE group. Conclusions: In terms of FHP, this metanalysis shows less FHP for the VEPE than conventional PE. A longer follow-up period is required to evaluate whether the oxidation protection gained by Vitamin E results in lower wear rates, less osteolysis, and aseptic loosening compared to the conventional PE in the long term.

scholarly journals Vitamin E-Enhanced Liners in Primary Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Qian-Yue Cheng ◽  
Bin-Fei Zhang ◽  
Peng-Fei Wen ◽  
Jun Wang ◽  
Lin-Jie Hao ◽  
...  
Keyword(s):  
Vitamin E ◽  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Rate ◽  
Meta Analysis ◽  
Harris Hip Score ◽  
Head Penetration ◽  
Total Hip ◽  
Femoral Head Penetration

Objective. Adding vitamin E to highly cross-linked polyethylene liners is frequently performed in clinical practice, aiming at reducing liner wear, increasing liner survival, and delaying revision surgery. This study is aimed at evaluating the revision rate, total femoral head penetration, and postoperative clinical function of highly cross-linked polyethylene liners with and without vitamin E in total hip arthroplasty. Methods. We conducted a systematic literature search to identify the use of highly cross-linked vitamin E liners compared to other liners in patients who received total hip arthroplasty (THA) before April 2021. The study quality assessment and data collection were conducted by two independent reviewers. Studies were artificially grouped, and vitamin E-enhanced liners (VE-PE) were compared with vitamin E-free liners (non-VE-PE). Analyses were executed using Review Manager version 5.4.1. Results. From the preliminary screening of 568 studies, fourteen studies met the research criteria. Compared to non-VE-PE, using VE-PE reduced the all-cause revision rate ( odds   ratio = 0.54 ; 95% confidence interval (CI) 0.40, 0.73; P < 0.0001 ). The total femoral head penetration of the VE-PE was lower than that of the non-VE-PE ( mean   difference = − 0.10 ; 95% CI -0.17, -0.03; P = 0.007 ). However, there was no difference in clinical function, including the Harris Hip Score and EuroQol Five-Dimension Questionnaire scores. Conclusion. Compared to the liners without vitamin E, the addition of vitamin E to liners could reduce the all-cause revision rate by approximately 46% in the short-term follow-up. In addition, even though addition of vitamin E could also slow down femoral head penetration, there is no contribution to clinical function.

A randomized double-blind noninferiority trial, evaluating migration of a cemented vitamin E-stabilized highly crosslinked component compared with a standard polyethylene component in reverse hybrid total hip arthroplasty

2019 ◽  
Vol 101-B (10) ◽  
pp. 1192-1198 ◽  
Author(s):  
Olof G. Sköldenberg ◽  
Agata D. Rysinska ◽  
Ghaz Chammout ◽  
Mats Salemyr ◽  
Sebastian S. Mukka ◽  
...  
Keyword(s):  
Vitamin E ◽  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Clinical Results ◽  
Head Penetration ◽  
Proximal Migration ◽  
Low Head ◽  
Acetabular Components ◽  
Total Migration

Aims Radiostereometric analysis (RSA) studies of vitamin E-doped, highly crosslinked polyethylene (VEPE) liners show low head penetration rates in cementless acetabular components. There is, however, currently no data on cemented VEPE acetabular components in total hip arthroplasty (THA). The aim of this study was to evaluate the safety of a new cemented VEPE component, compared with a conventional polyethylene (PE) component regarding migration, head penetration, and clinical results. Patients and Methods We enrolled 42 patients (21 male, 21 female) with osteoarthritis and a mean age of 67 years (sd 5), in a double-blinded, noninferiority, randomized controlled trial. The subjects were randomized in a 1:1 ratio to receive a reverse hybrid THA with a cemented component of either argon-gas gamma-sterilized PE component (controls) or VEPE, with identical geometry. The primary endpoint was proximal implant migration of the component at two years postoperatively measured with RSA. Secondary endpoints included total migration of the component, penetration of the femoral head into the component, and patient-reported outcome measurements. Results In total, 19 control implants and 18 implants in the VEPE group were analyzed for the primary endpoint. We found a continuous proximal migration of the component in the VEPE group that was significantly higher with a difference at two years of a mean 0.21 mm (95% confidence interval (CI) 0.05 to 0.37; p = 0.013). The total migration was also significantly higher in the VEPE group, but femoral head penetration was lower. We found no difference in clinical outcomes between the groups. Conclusion At two years, this cemented VEPE component, although having a low head penetration and excellent clinical results, failed to meet noninferiority compared with the conventional implant by a proximal migration above the proposed safety threshold of RSA. The early proximal migration pattern of the VEPE component is a reason for continued monitoring, although a specific threshold for proximal migration and risk for later failure cannot be defined and needs further study. Cite this article: Bone Joint J 2019;101-B:1192–1198

scholarly journals Does vitamin E highly-crosslinked polyethylene convey an advantage in primary total hip replacement? A systematic review and meta-analysis

2019 ◽  
Vol 30 (5) ◽  
pp. 598-608 ◽  
Author(s):  
Michael C Wyatt ◽  
Andrew Roberton ◽  
Michael Foxall-Smi ◽  
Andrew D Beswick ◽  
Setor K Kunutsor ◽  
...  
Keyword(s):  
Systematic Review ◽  
Vitamin E ◽  
Femoral Head ◽  
Hip Replacement ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Initial Screening ◽  
Head Penetration ◽  
Clinically Significant ◽  
Femoral Head Penetration

Background: Vitamin E highly cross-linked polyethylene (HXLPE) was developed to reduce wear in total hip replacement (THR). This formal systematic review and meta-analysis aimed to provide independent synthesis of wear characteristics of Vitamin E treated HXLPE compared to HXPLE/UHMWPE. Secondary outcome measures were differences in revision rates and functional scores. Methods: We performed a formal systematic review as per PRISMA guidelines; literature searches were conducted on 14 November 2017 (MEDLINE, Embase on Ovid, and the Cochrane Library). We included randomised controlled trials, analyses of joint registries, and case-controlled studies of primary THR comparing cups with a vitamin E HXLPE bearing with bearing surfaces made from other types of polyethylene. Initial screening was performed by 2 independent assessors; disagreement resolved in discussion with a third reviewer. Studies were evaluated using the Cochrane risk of bias tool. Data extraction permitted meta-analysis. Results: 372 studies were identified on initial screening, 5 studies met the eligibility criteria. There was no significant heterogeneity between studies. There was variable risk of bias. At a mean of 35 (range 20–60) months, Vitamin E HXLPE had significant advantages over highly cross-linked polyethylene with regards total femoral head penetration ( p = 0.004). Given the RSA measurement errors this may not be clinically significant. There were neither significant differences in revision rates nor Harris Hip Scores ( p = 0.06). Conclusion: At a minimum of 3 years follow-up there was reduced total femoral head penetration for vitamin E HXLPE over HXLPE. This bearing surface does not, as yet, have clinically significant advantages in terms of revision rates or patient function over HXLPE.

Comparison of Steady State Femoral Head Penetration Rates Between Two Highly Cross-Linked Polyethylenes in Total Hip Arthroplasty

2010 ◽  
Vol 25 (5) ◽  
pp. 680-686 ◽  
Author(s):  
John-Paul Whittaker ◽  
Kory D. Charron ◽  
Richard W. McCalden ◽  
Steven J. MacDonald ◽  
Robert B. Bourne
Keyword(s):  
Steady State ◽  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Head Penetration ◽  
Total Hip ◽  
Femoral Head Penetration

Assessing the pattern of femoral head penetration after total hip arthroplasty

2004 ◽  
Vol 19 (7) ◽  
pp. 22-29 ◽  
Author(s):  
Robert H. Hopper ◽  
Anthony M. Young ◽  
C.Anderson Engh ◽  
James P. McAuley
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Head Penetration ◽  
Total Hip ◽  
Femoral Head Penetration

scholarly journals Vitamin E-doped total hip arthroplasty liners show similar head penetration to highly cross-linked polyethylene at five years: a multi-arm randomized controlled trial

2020 ◽  
Vol 102-B (10) ◽  
pp. 1303-1310 ◽  
Author(s):  
Kristian Kjærgaard ◽  
Ming Ding ◽  
Carsten Jensen ◽  
Charles Bragdon ◽  
Henrik Malchau ◽  
...  
Keyword(s):  
Vitamin E ◽  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Head Penetration ◽  
Total Hip ◽  
Component Migration

Aims The most frequent indication for revision surgery in total hip arthroplasty (THA) is aseptic loosening. Aseptic loosening is associated with polyethylene liner wear, and wear may be reduced by using vitamin E-doped liners. The primary objective of this study was to compare proximal femoral head penetration into the liner between a) two cross-linked polyethylene (XLPE) liners (vitamin E-doped (vE-PE)) versus standard XLPE liners, and b) two modular femoral head diameters (32 mm and 36 mm). Methods Patients scheduled for a THA were randomized to receive a vE-PE or XLPE liner with a 32 mm or 36 mm metal head (four intervention groups in a 2 × 2 factorial design). Head penetration and acetabular component migration were measured using radiostereometric analysis at baseline, three, 12, 24, and 60 months postoperatively. The Harris Hip Score, University of California, Los Angeles (UCLA) Activity Score, EuroQol five-dimension questionnaire (EQ-5D), and 36-Item Short-Form Health Survey questionnaire (SF-36) were assessed at baseline, three, 12, 36, and 60 months. Results Of 220 screened patients, 127 were included in this study. In all, 116 received the allocated intervention, and 94 had their results analyzed at five years. Head penetration was similar between liner materials and head sizes at five years, vE-PE versus XLPE was -0.084 mm (95% confidence interval (CI) -0.173 to 0.005; p = 0.064), and 32 mm versus 36 mm was -0.020 mm (95% CI -0.110 to 0.071; p = 0.671), respectively. No differences were found in acetabular component migration or in the patient-reported outcome measures. Conclusion No significant difference in head penetration was found at five years between vE-PE and XLPE liners, nor between 32 mm and 36 mm heads. Cite this article: Bone Joint J 2020;102-B(10):1303–1310.

Sign in / Sign up

Export Citation Format

Share Document