Second-Generation Highly Cross-Linked Polyethylene In Total Hip Arthroplasty

Bearing materials that are used in total hip arthroplasty have undergone major developments in structure and durability since the 1960s.Osteolysis and aseptic loosening associated with ultra-high molecular weight polyethylene had been a major concern; this led to the development of the first generation of highly cross-linked polyethylene (HXLPE), which was followed by a second generation of HXLPE.The second generation of HXLPE was introduced with the aim of providing oxidative stability while maintaining high wear resistance.Oxidative stabilization methods include mechanical deformation and annealing, incorporation of antioxidant-containing materials, high-pressure crystallization after melting, and polyethylene surface-grafting with a biocompatible polymer.Results of clinical studies with <= 5 years of follow-up have shown that second-generation HXLPE acetabular liners are superior to any of the previous generation with regard to wear rates; however, additional studies are needed to compare second-generation materials among each other.