Comparison between highly cross-linked and conventional polyethylene in total knee arthroplasty
Introduction
Polyethylene wear in total joint arthroplasty is one of the most important factors affecting mid- and long-term clinical results [1], [2], [3], [4], [5]. Therefore, many new designs and materials have recently been introduced for total joint prostheses to reduce polyethylene wear and to achieve better long-term results. In the 1990s, highly cross-linked polyethylene was developed, and is now widely used for total hip arthroplasty (THA). Reduction of wear with highly cross-linked polyethylene has been reported in in vitro and in vivo studies of total hip prostheses [6], [7], [8], [9], [10], [11], [12], [13]. Recently, knee simulator studies have shown that highly cross-linked polyethylene improves both adhesive and abrasive wear resistance as well as delamination resistance [14], [15], [16]. However, reduced fracture toughness and the generation of smaller and more reactive particles have been reported with it [11]. Since there has been only a limited information [17] on in vivo clinical results of total knee arthroplasty using highly cross-linked polyethylene, the use of highly cross-linked polyethylene in total knee prostheses remains controversial [18], [19], [20], [21].
The aim of the present study was to compare early clinical and radiographic results of use of conventional polyethylene and highly cross-linked polyethylene (Prolong; Zimmer, Warsaw, IN, USA) in total knee prostheses of the same design (NexGen CR; Zimmer, Warsaw, IN, USA), and to investigate early failure due to use of this new material.
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Materials and methods
We began use of a cruciate retaining (CR) total knee prosthesis (NexGen CR) in January 2001. All the operations were performed by a single surgical team using the same procedure. Given the likelihood of existence of a learning curve for this component, 207 consecutive knees (187 patients) undergoing primary total knee arthroplasty (TKA) from January 2002 to July 2004 were analyzed in the present study. During this period, we used NexGen CR for all the cases of primary TKA. First consecutive 115
Results
Preoperative demographic data was shown in Table 1. Differences in the age, gender, and diagnosis between two groups were not statistically significant. Preoperative range of motion of the knee, and Knee Society Score [11] was better in highly cross-linked polyethylene group.
Range of motion and Knee Society Score at 2 years after the operation is summarized in Table 2. The difference of range of motion and Knee Society Score (knee score and function score) between groups was not statistically
Discussion
The present study showed that differences in the postoperative clinical scores, range of motion, and radiographic results of CR TKA between highly cross-linked and conventional polyethylene with the same design were not significant. Our results showed that there was no early failure due to use of the new material. To our knowledge, there has been only a limited information on in vivo clinical results of TKA using highly cross-linked polyethylene [17]. Hodrick et al. reported that less
Acknowledgements
The authors thank Rika Onishi, secretary of Knasai Rosai Hospital, for her assistance with this study.
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