Commentary on the medium-term results of ceramic-on-polyethylene Zweymüller-Plus total hip arthroplasty

[...]the high number of patients lost to follow-up (13.5%) might have underestimated the revision rate and overestimated the overall survival of the prostheses. In their meta-analysis, Kurtz et al19 also investigated the incidence of osteolysis in patients with UHMWPE liners and HXLPE liners by calculating odds ratios from individual cohort (n=8) and randomised controlled trial (n=1) studies with a minimum of 5-year follow-up. The combined and the pooled odds ratio was estimated to be 0.131 (95% confidence interval [CI], 0.064-0.268) using a random-effects model which indicates that the incidence of osteolysis was 87% lower in patients with HXLPE liners compared with patients with conventional polyethylene liners.19 Hanna et al20 followed a cohort of 160 patients (179 THAs) between the ages of 45 and 65 years who received liners made of either UHMWPE (n=89) or HXLPE (n=88). The cumulative implant survival, with revision for polyethylene wear or osteolysis as an endpoint, was 86% (95% CI, 78%-94%) in the UHMWPE group and 100% in the HXLPE group at 13 years postoperatively.20 Data from a United States registry also suggested that the revision rates for THAs utilising HXLPE are lower than that for non-crosslinked UHMWPE.