Introduction Since their introduction circa 2000, highly cross-linked polyethylene (HXLPE) liners have demonstrated excellent wear resistance in total hip arthroplasty (THA), although there is limited long-term data directly comparing outcomes between HXLPE and conventional polyethylene (CPE) liners. This study aims to compare the 20-year implant survivorship and clinical outcomes in patients who underwent THA using HXLPE or CPE liners. Methods A retrospective review was performed for all patients under 65 who underwent a primary THA at our institution between January 2000 and December 2003, using a CPE or HXLPE acetabular liner and a 28mm cobalt-chromium femoral head. We identified 331 hips in 282 patients: 117 hips received CPE liners and 214 received HXLPE liners. The mean age, body mass index (BMI), and follow-up were 59 years, 31 kg/m2, and 18 years in the CPE group and 53 years, 31 kg/m2, and 17 years in the HXLPE group. Results At 20 years, survivorship free from all-cause revision was 94% for HXLPE and 65% for CPE; for polyethylene wear–related revision, survivorship was 100% for HXLPE and 77% for CPE. HXLPE was associated with a significantly lower hazard of all-cause revision compared to CPE (HR = 0.184, p < 0.001), indicating patients with CPE were approximately five times more likely to undergo revision. For polyethylene wear–related revision, no events were observed in the HXLPE group, resulting in a significantly lower risk compared to CPE (HR = 0.006, p = 0.014). The indications for revision were polyethylene wear (n=23, only in the CPE cohort), aseptic loosening (n=5, only in the CPE cohort), instability (n=11), infection (n=5), periprosthetic fracture (n=2), and non-union of subtrochanteric osteotomy (n=1). At final follow-up, the mean modified Harris hip score (HHS) was significantly higher in the HXLPE group (81 vs. 76, p = 0.03), while the mean Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score was similar between groups (76 vs. 72, p = 0.21). Conclusion At 20-year follow-up, HXLPE liners continue to outperform CPE liners with significantly improved survivorship and no wear-related revisions documented in the HXLPE group. These findings support the long-term durability and clinical advantage of HXLPE in THA.
McCalden et al. (Thu,) studied this question.