Li Chenkai, Zhang Haining
Department of Joint Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
BMC Musculoskelet Disord. 2020 Oct 10;21(1):670. doi: 10.1186/s12891-020-03697-1.
Highly cross-linked polyethylene (HXLPE) enhances the anti-wear characteristics of the conventional polyethylene (PE). Early failure for wear after ceramic-on-highly cross-linked polyethylene (CoHXLPE) total hip arthroplasty (THA) is extremely rare.
We described the case of a 60-year-old man who underwent right CoHXLPE THA because of the developmental dysplasia hip (DDH) complained pain 32 months after this procedure. Plain radiographs showed that eccentric wear existed at the polyethylene insert. However, the patient refused surgery at that time and did not stop weight-bearing. The right hip pain continued for 7 months. Plain radiographs of the pelvis showed that the HXLPE liner was penetrated and partial inner wall of acetabular shell was worn. Acetabular cup revision was performed, and the ceramic head and HXLPE were exchanged.
Difficult reduction during primary THA, especially for DDH, can result in higher abductor tension, which may lead to early eccentric wear of the prosthesis. Whenever eccentric wear of HXLPE liner was found, weight-bearing must be stopped to avoid the accelerated wear and adverse reactions to metal debris (ARMD).
高交联聚乙烯（HXLPE）增强了传统聚乙烯（PE）的抗磨损特性。陶瓷对高交联聚乙烯（CoHXLPE）全髋关节置换术（THA）后因磨损导致的早期失败极为罕见。
我们描述了一名60岁男性的病例，该患者因发育性髋关节发育不良（DDH）接受了右侧CoHXLPE THA手术，术后32个月出现疼痛。X线平片显示聚乙烯内衬存在偏心磨损。然而，患者当时拒绝手术且未停止负重。右髋疼痛持续了7个月。骨盆X线平片显示HXLPE衬垫已穿透，髋臼杯内壁部分磨损。遂进行了髋臼杯翻修术，更换了陶瓷头和HXLPE。
初次THA手术中复位困难，尤其是对于DDH患者，可能导致外展肌张力增加，这可能会导致假体早期偏心磨损。一旦发现HXLPE衬垫出现偏心磨损，必须停止负重，以避免加速磨损和对金属碎屑的不良反应（ARMD）。
