A Review of Early In Vivo Performance of Antioxidant Stabilized Polyethylene for Total Knee Arthroplasty

Background: The incorporation of antioxidants into highly cross-linked polyethylene (HXLPE) has emerged as an alternative to postirradiation thermal treatments for improving oxidation resistance. Currently, use of antioxidant stabilized HXLPE (AO-XLPE) in total knee arthroplasty (TKA) is increasing. In this literature review, we asked: (1) How does the clinical performance of AO-XLPE compare to con-ventional ultra-high molecular weight polyethylene (UHMWPE) or HXLPE for TKA? (2) What material changes occur in vivo for AO-XLPE in TKA? and (3) What is the risk of revision for AO-XLPE in TKA?Methods: We performed a search of the literature according to the Preferred Reporting Items for Sys-tematic Review and Meta-Analyses guidelines using PubMed and Embase. Included studies reported the in vivo behavior of vitamin E-doped polyethylene in TKA. We reviewed 13 studies.Results: Across the studies, clinical results including revision rates, patient-reported outcome mea-surement scores, and the occurrence of osteolysis or radiolucent lines tended to be similar for AO-XLPE as compared to conventional UHMWPE or HXLPE controls. In retrieval analyses, AO-XLPE exhibited excellent resistance to oxidation and typical surface damage. Survival rates were positive and not significantly different from conventional UHMWPE or HXLPE. There were no cases of osteolysis for AO-XLPE and no revision due to polyethylene wear reported.Conclusion: The purpose of this review was to provide a comprehensive overview of the literature regarding the clinical effectiveness of AO-XLPE in TKA. Overall, the results of our review indicated positive early-to mid-term clinical performance for AO-XLPE in TKA and similar outcomes as compared to conventional UHMWPE and HXLPE.& COPY; 2023 Elsevier Inc. All rights reserved.

Automated summary

This literature review aimed to evaluate the clinical performance and material changes of antioxidant stabilized highly cross-linked polyethylene (AO-XLPE) in total knee arthroplasty (TKA). The study found that AO-XLPE exhibited similar clinical outcomes as conventional materials, with excellent resistance to oxidation and surface damage, and no cases of osteolysis or revision due to polyethylene wear.