In Vivo Oxidation and Wear in Remelted Highly Cross-Linked Polyethylene Liners Retrieved at a Minimum of 10 Years After Total Hip Arthroplasty

Background: With the decreasing age threshold for patients undergoing total hip arthroplasty (THA), there is an escalating demand for enhanced polyethylene durability. Although reports assessing wear in remelted highly cross-linked polyethylene (HXLPE) through radiographic imaging exist, a consensus regarding its oxidation level is lacking. This study investigated the wear, oxidation levels, and degradation of remelted HXLPE that was retrieved at least 10 years after THA. Methods: Our analysis focused on 7 cases of melted HXLPE liners retrieved >= 10 years after THA. All patients were women, who had an average age of 64 +/- 6.5 years at the initial operation, and the mean postoperative period after THA was 12 years and 11 months +/- 1 year and 5 months. The wear conditions were measured by matching the shape analysis data obtained from a coordinate-measuring machine with a spherical model. Fourier-transform infrared spectroscopy was used to study the oxidation of polyethylene, and the polyethylene structure was evaluated using scanning electron microscopy. Results: Osteolysis was not observed in any case on X-rays, computed tomography, or intraoperative findings during revision surgery. The average oxidation index (OI) of the sliding surface under load was 0.31 +/- 0.22 in the 6 cases calculated after hexane treatment, and 0.69 for one case without hexane treatment. In the 6 cases calculated after hexane treatment, the average OI of the non-load-bearing sliding surface was 0.11 +/- 0.20. Average wear values were 0.33 +/- 0.11 mm at 45 degrees from the equatorial direction and 0.04 +/- 0.07 mm in the opposite direction. The initial structure of the polyethylene was preserved at all sites with low oxidation levels; however, in one case with stem subsidence, morphological changes and a high OI were observed. Conclusions: Long-term oxidation and wear of remelted HXLPE liners retrieved from THA patients were minimal. (c) 2024 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).