Hip resurfacing arthroplasty with cemented highly cross-linked all polyethylene acetabular components

Background: Hip resurfacing arthroplasty (HRA) is needed for certain patients, such as those with in situ metal work and abnormal anatomy, and/or other needs that are not well-served by total hip replacement (THR). Over the last 20 years, almost all HRAs have been performed using Metal-on-Metal (MoM) bearings, but metal wear debris generated over time has now ended their continued use. Cemented highly cross-linked polyethylene (XLPE) acetabular bearings have shown excellent survivorship for use in THR and the aim of this study is to determine if this also applied to HRA.

Methods: This prospective cohort study evaluated extending the use of cemented XLPE acetabular bearings to HRA. There were 122 HRA patients who received a cemented XLPE acetabular component. They were followed for a mean 15 years (range, 10–20 years). There were 65 women (53%) and 57 men (47%). The mean age at surgery was 49.2 years (range, 21–68 years) the mean body mass index (BMI) was 26 kg/m². Clinical outcomes and survivorship were determined. Analyses of implants retrieved during revision or postmortem were performed to evaluate consequences of wear debris.

Results: The 10-year survival rate for 122 hips was 93.5% [95% confidence interval (CI): 91.7–98.1%] for all-cause revision. Six acetabular bearings failed, requiring revision for: loosening [2], polyethylene wear [2], and dislocation [2]. Four additional well-functioning XLPE bearings were retrieved postmortem. Two well-functioning cemented acetabular bearings were also retrieved; one was an explant for an infection after 9 years and the other was retrieved during revision to THR because of femoral head avascular necrosis at 6 years. Analysis of the 12 retrievals found signs of limited anterior/superior wear in all bearings along with minimal wear in the dome of 10 bearings. Only two retrieved bearings had more than 50% of the anterior/superior area worn and these were after 15 and 20 years of use. Two of the retrieved implants had no signs of wear.

Conclusions: Cemented all XLPE acetabular bearings produced successful clinical outcomes initially in all patients. Six (4.9%) patients required revision for acetabular failure. Anterior/superior wear was found in the retrievals, but dome wear was limited. Cementing an XLPE acetabular component is a reasonable approach in HRA, but since it does not allow adjunct screw fixation that a metal-backed two-piece component can offer, it is not a solution for every HRA.