Wear of highly crosslinked polyethylene acetabular components

Figures & data

Flow chart of the systematic search performed of the PubMed, Scopus, and Cochrane databases.

Table 1. Implants used in each patient cohort

Cohort	Publication	XLPE component	Head size, mm	Head material	Femoral component
1	Digas et al. 2003;	Durasul (Zimmer)	28	CoCr	Spectron (Smith & Nephew)
	Digas et al. 2004;
	Digas et al. 2007;
	Johanson et al. 2012
2	Digas et al. 2004;	Longevity liner within Trilogy shell (Zimmer)	28	CoCr	Spectron (Smith & Nephew)
	Digas et al. 2007
3	Rohrl et al. 2005;	Osteonics Cup made of Crossfire PE (Stryker Orthopaedics)	28	CoCr	Exeter Femoral Stem (Stryker Orthopaedics)
	Rohrl et a.l 2007;
	Rohrl et a.l 2012
4	Zhou, et al. 2006	XLPE 10 within Reflection Shell (Smith and Nephew)	28	CoCr	Spectron (Smith & Nephew)
5	Bragdon et al. 2007	Longevity liner within Trilogy Shell (Zimmer)	28	NR	NR
6	Bragdon et al. 2007	Longevity liner within Trilogy Shell (Zimmer)	36	NR	NR
7	Glyn-Jones et al. 2008a;	Longevity liner within Trilogy Shell (Zimmer)	28	CoCr	CPT (Zimmer)
	Glyn-Jones et al. 2008b;
	Thomas et al. 2011
8	Ayers et al. 2009	Longevity liner within Trilogy Shell (Zimmer)	28	NR	ML Taper (Zimmer)
9	Campbell et al. 2010a;	Marathon liner within Pinnacle Shell (Depuy Orthopaedics)	28	CoCr	Corail (Depuy Orthopaedics)
	Callary et al. 2013a
10	Campbell et al. 2010b;	X3 liner within Trident Shell	32	CoCr	Accolade
	Callary et al. 2013b	(Stryker Orthopaedics)		(Stryker Orthopaedics)
11	Kadar et al. 2011	Reflection All-Poly XLPE (Smith & Nephew)	28	CoCr	Spectron EF (Smith & Nephew)
12	Kadar et al. 2011	Reflection All-Poly XLPE (Smith & Nephew)	28	Oxinium	Spectron EF (Smith & Nephew)

NR: not reported.

Table 2. Details of RSA studies

Cohort	Age (range)	Number of patients	Follow-up, months	Report	Years of follow-up	Number of patients included in RSA results	Software	Acetabular reference	Standing/Supine
1	Median 54 (35–68)	31	within 7 days,	1st	2	(Digas et al. 2003); 23 supine, 21 standing	UmRSA	B	Supine ^a
			3, 6, 12, 24, 36	2nd	3	(Digas et al. 2004); 20 supine, 18 standing
			60, 84, 120	3rd	5	(Digas et al. 2007); 28 supine, 22 standing
				4th	10	(Johanson et al. 2012); 23 supine
2	Median 48 (29–70)	32	within 7 days, 3,	1st	2	(Digas et al. 2004); 22 supine, 20 standing	UmRSA	B	Supine ^a
			6, 12, 24, 36, 60	2nd	5	(Digas et al. 2007); 19 supine, 12 standing
3	Mean 58 (49–79)	10	within 7 days,	1st	3	(Rohrl et al. 2005); 10	UmRSA	B	Supine
			2, 12, 24, 36, 60,	2nd	6	(Rohrl et al. 2007); 9
			72, 120	3rd	10	(Rohrl et al. 2012); 8
4	Mean 68 (53–83)	30	3 to 7 days, 2, 12, 24	1st	2	(Zhou et al. 2006); 28	UmRSA 6.0	B+E	Supine
5	Mean 56 (36–77)	16	6 weeks, 6, 12, 24, 36	1st	3	(Bragdon et al. 2007); 16(25/30 ^b)	UmRSA 6.0	B; B+ E; E	Standing
6	Mean 56 (36–77)	14	6 weeks, 6,12, 24, 36	1st	3	(Bragdon et al. 2007); 14 (25/30 ^b)	UmRSA 6.0	B; B+ E; E	Standing
7	Mean 68 (52–76)	27	PO, 3, 6, 12, 24, 36, 60, 84	1st 2nd 3rd	2	(Glyn-Jones et al. 2008a); 26 3 (Glyn-Jones et al. 2008b); 26 7 (Thomas et al. 2011); 22	Gill et al. 1998	Un-bedead	Standing
8	Mean 58 (SD 8)	24	6 weeks, 6, 12, 24	1st	2	(Ayers et al. 2009); 24	UmRSA	B	Standing
9	Median 72 (55–80)	30	4–6 days, 6, 12, 24, 72	1st 2dn	2	(Campbell et al. 2010a); 25 6 (Callary et al. 2013a); 24	UmRSA 6.0	B+E	Supine
10	Median 63 (47–76)	21	Within 7 days, 6, 12, 24, 60	1st 2nd	2	(Campbell et al. 2010b); 19 5 (Callary et al. 2013b); 18	UmRSA 6.0	B+E	Supine
11	Mean 70 (SD 5)	30	9–15 days, 3, 6, 12, 24	1st	2	(Kadar et al. 2011); 29	UmRSA 5.0	B	Supine
12	Mean 70 (SD 5)	30	9–15 days, 3, 6, 12, 24	1st	2	(Kadar et al. 2011); 24	UmRSA 5.0	B	Supine

^a Supine and standing from 3 months.

^b Combined number of patients included in wear results for cohorts 5 and 6.

B: beaded; B+E: beaded plus ellipse; E: ellipse

Table 3. Precision of RSA from double examinations in each cohort

Cohort	Publication in which precision was reported	Original calculation method	Number of double examinations	Adjusted precision
				x	y	z	3D
1	Digas et al. 2003	99% CI	45	0.10	0.08	0.15	0.17
2	Digas et al. 2004	99% CI	45	^a	^a	^a	^a
3	Rohrl et al. 2007	95% CI	99	^b	0.08	^b	0.16
	Rohrl et al. 2012	1.96 × SD	^b	^b	0.09	^b	0.31
4	Zhou et al. 2006	Beaded 1.96 × SD	28	^b	0.08	^b	0.22
		Ellipse 1.96 × SD	28	^b	0.10	^b	0.28
5 and 6	^b	^b	^b	^b	^b	^b	^b
7	^b	^b	^b	^b	^b	^b	^b
8	^b	^b	^b	^b	^b	^b	^b
9	Campbell et al. 2010a	95% CI	22	0.03	0.02	0.07	^b
10	^b	^b	^b	^b	^b	^b	^b
11 and 12	Kadar et al. 2011	2.009 × SD	50	0.11	0.11	0.33	0.21

^a Precision not specified for each axis, “between 0.07 and 0.32 mm”.

^b Not reported.

Table 4. Proximal and 3D femoral head penetration, bedding-in, and wear rate reported for each cohort in each follow-up report

Cohort	Follow-up years	Femoral head penetration^a (mm)	Bedding-in^b mm	Wear rate^c mm/year
Proximal
1	2 (Digas et al. 2003)	0.13 (0.03 to 0.31) ^d	0.1 ^d	0.03 ^f (3–24 m) ^e
	3 (Digas et al. 2004)	0.13 (-0.02 to 0.30) ^d	0.1 ^d, g	0.03 ^f (3–36 m) ^e
	5 (Digas et al. 2007)	0.15 (-0.10 to 0.86) ^d	0.1 ^d, g	0.02 ^f (3–60 m) ^e
	10 (Johanson et al. 2012)	0.15 ^g	0.1 ^d, g	0.01 (SE 0.00) (2–10 yr) ^d
2	2 (Digas et al. 2004)	0.08 (-0.03 to 0.28) ^d	0.08 ^d	0.03 ^f (3–24 m) ^e
	5 (Digas et al. 2007)	0.08 (-0.02 to 0.24) ^d	0.08 ^d, g	0.02 ^f(3–60 m) ^e
3	3 (Rohrl et al. 2005)	NR	0.05 (0–2 months)	0.01 (2–24 m)
	6 (Rohrl et al. 2007)	0.08 (CI 0.02 to 0.13)	0.06 ^g	0.01 (2–72 m)
	10 (Rohrl et al. 2012)	0.07 (CI -0.02 to 0.15)	0.06 ^g	0.00 (2–120 m)
4	2 (Zhou et al. 2006)	0.07 ^g	0.06 ^g	0.01 (2–24 m)
5	3 (Bragdon et al. 2007)	0.06 ^h (SE 0.03)	0.06 ^h (SE 0.04)	0.03 ^h (SE 0.02)
6	3 (Bragdon et al. 2007)	0.06 ^h (SE 0.06)	0.07 ^h (SE 0.02)	0.00 ^h (SE 0.06)
7	2 (Glyn-Jones et al. 2008a)	NR	NR	0.06 (SD 0.07) (3–24 m)
	3 (Glyn-Jones et al. 2008b)	NR	0.17 ^g	0.02 ^g
	7 (Thomas et al. 2011)	NR	NR	0.01 (CI ±0.03)
8	2 (Ayers et al. 2009)	0.07 ^h (-0.04 to 0.19)	0.07 ^h (-0.14 to 0.16)	0.02 ^g
9	2 (Campbell et al. 2010a)	0.12 (-0.10 to 0.38)	0.11 (-0.01 to 0.39)	0.01
	6 (Callary et al. 2013a)	0.19 (0.00 to 0.51)	0.11 (-0.01 to 0.39)	0.01 (-0.02 to 0.06)
10	2 (Campbell et al. 2010b)	0.02 ^h (-0.07 to 0.16)	0.01 ^h (-0.09 to 0.12)	0.02 ^h
	5 (Callary et al. 2013b)	0.02 (-0.11 to 0.13)	0.01 (-0.09 to 0.12)	0.00 (-0.03 to 0.03)
11	2 (Kadar et al. 2011)	0.09 (CI 0.06–0.12)	0.06 ^g	0.03
12	2 (Kadar et al. 2011)	0.08 (CI 0.04–0.12)	0.06 ^g	0.02
3D
1	2 (Digas et al. 2003)	0.18 (0.07–0.35) ^d	0.15 ^d	0.11 ^f (3–24 m) ^e
	3 (Digas et al. 2004)	0.23 (0.04–0.41) ^d	0.18 ^d, g	0.09 ^f (3–36 m) ^e
	5 (Digas et al. 2007)	0.23 (0.02–0.91) ^d	NR	0.04 ^f (3–60 m) ^e
	10 (Johanson et al. 2012)	0.22 ^d, g	0.18 ^d, g	0.01 ^f (SE 0.00) (2–10 yr) ^d
2	2 (Digas et al. 2004)	0.22 (0.05–0.40) ^d	0.25 (supine)	0.19 ^f(3–24 m) ^e
	5 (Digas et al. 2007)	0.20 (0.10–0.61) ^d	0.24 (supine)	0.07 ^f(3–60 m) ^e
3	3 (Rohrl et al. 2005)	0.17 (CI 0.06–0.28)	NR	NR
	6 (Rohrl et al. 2007)	0.23 (CI 0.10–0.35)	NR	0.03 (2–72 m)
	10 (Rohrl et al. 2012)	0.20 (CI 0.03–0.36)	0.19 ^g	0.00 ^f(2–120 m)
4	2 (Zhou et al. 2006)	0.19 ^g	0.15 ^g	0.03 ^f(2–24 m)
5	3 (Bragdon et al. 2007)	NR	NR	NR
6	3 (Bragdon et al. 2007)	NR	NR	NR
7	2 (Glyn-Jones et al. 2008a)	0.31 (SD 0.18)	0.30 ^g	0.06 (SD 0.06) (3–24 m)
	3 (Glyn-Jones et al. 2008b)	0.35 (SD 0.14)	0.26 (SD 0.17)	0.03 (SD 0.06)
	7 (Thomas et al. 2011)	0.33 (CI ± 0.10)	0.29 (95% CI ±0.07)	0.01 (CI ± 0.02)
8	2 (Ayers et al. 2009)	NR	NR	NR
9	2 (Campbell et al. 2010a)	0.23 (0.02–0.84)	0.23 (0.06 to 0.93)	0.00 ^f
	6 (Callary et al. 2013a)	0.32 (0.05–0.60)	0.23 (0.06 to 0.93)	0.018 (-0.11 to 0.08)
10	2 (Campbell et al. 2010b)	0.16 ^h (0.07–0.26)	0.16 ^h (0.02 to 0.32)	-0.04 ^h
	5 (Callary et al. 2013b)	0.15 (0.04–0.32)	0.19 (0.02 to 0.32)	-0.01 (-0.06 to 0.04)
11	2 (Kadar et al. 2011)	0.19 (CI 0.15–0.23)	NR	NR
12	2 (Kadar et al. 2011)	0.18 (CI 0.13–0.22)	NR	NR

CI: 95% confidence interval

NR: not reported.

^a Initial to final follow-up unless otherwise noted; mean (range).

^b Initial examination to 1-year follow-up unless otherwise noted; mean (range).

^c Annual rate from 1-year follow-up to final follow-up unless otherwise noted; mean (range).

^d Supine

^e Standing

^f Manually calculated to be rate/year from a reported value given after bedding-in.

^g Visualized from graph

^h Median

Table 5. Recommendations to enhance reporting of RSA wear results

Recommendations to enhance reporting of RSA wear results
Methodology
1 Components used (femoral head size and material; description of XLPE component)
2 Patient positioning (supine or standing)
3 Software and acetabular reference segment used
Results
4 Allow one year for bedding-in and creep, and report results using the terms:   – femoral head penetration (initial examination to latest follow-up)   – bedding-in (initial examination to the one-year examination)   – wear rate (the annual wear rate between the one-year examination and latest follow-up)
5 Report axis of measurement (x, y, z, 2D or 3D)
6 Use scatter plots of wear results to allow identification of outliers

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