Wear, Osteolysis, and Aseptic Loosening Following Total Hip Arthroplasty in Young Patients with Highly Cross-Linked Polyethylene: A Review of Studies with a Follow-Up of over 15 Years

Total hip arthroplasty (THA) has in recent years trended toward a younger, more physically demanding patient population. Mid- to long-term studies of all ages of THA patients using highly cross-linked polyethylene (HXLPE) have been favorable, but concerns about its long-term failure and wear-related complications remain for young THA patients. In this narrative review, a search of the PubMed/MEDLINE and Cochrane databases was performed, and we identified six studies with a minimum 15-year follow-up of HXLPE with various femoral head materials. Wear-related revisions were exceedingly low for patients under the age of 55, with variable reports of non-clinically significant osteolysis. Higher activity levels, a larger femoral head size, and femoral head material were not associated with greater long-term wear rates. Young THA with metal or ceramic on HXLPE is exceedingly durable with favorable outcomes at follow-ups of over 15 years.

Automated summary

Studies have shown that total hip arthroplasty (THA) using highly cross-linked polyethylene (HXLPE) has favorable outcomes in the mid-to-long term for patients of all ages. Concerns about long-term failure and wear-related complications remain for young THA patients. However, research has found that wear-related revisions are low for patients under the age of 55, and factors such as higher activity levels, larger femoral head size, and femoral head material do not affect long-term wear rates. Young THA patients who have undergone the procedure with metal or ceramic on HXLPE have shown excellent durability and favorable outcomes in follow-ups of over 15 years.