Liu Fanxiao, Gao Ling, Wang Dawei, Zhang Qingyu
Department of Orthopaedics, Liaocheng People's Hospital, Liaocheng, Shandong, P.R. China.
Department of Orthopaedics, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, P.R. China.
J Orthop Surg Res. 2025 Jan 20;20(1):72. doi: 10.1186/s13018-024-05402-7.
Vitamin E-diffused highly cross-linked polyethylene (HXLPE/Vit E) is a relatively advanced material used in total hip arthroplasty (THA) but whether it shows superiority is unclear.
This meta-analysis was performed to investigate the effect of HXLPE/Vit E liners in THA.
Medline/PubMed, Embase and Cochrane Library databases were searched to retrieve studies assessing the efficacy of HXLPE/Vit E liners in THA with the design of a randomized, controlled trial. Meta-analyses were conducted to merge the outcome estimates of interest, such as the femoral head penetration (FHP), FHP rate, FHP in x- (medial/lateral), y- (vertical) and z- (anteroposterior) axes, cup inclination angle, Harris hip score (HHS), numeric rating scale (NRS) and complications. Then pooled outcomes at different time points during the follow-up period were calculated.
Follow an elaborate search of related databases, 23 studies involving a total of 54,920 participants were deemed eligible for this meta-analysis. The pooled results revealed significant decreased FHP at the last follow-up (pooled Mean Difference [MD] = -0.10, 95% confidence intervals [CIs]: -0.14 to -0.06). The subgroup analysis revealed a consistent trend at different time points during the follow-up. Significant decrease in the FHP rate were identified at the postoperative 1-2 years (pooled MD = -0.01, 95% CIs: -0.02 to -0.00) rather than at 2-5, 5-7, and 7-10 years. The combined results of clinical scores demonstrated no significant changes in the HHS, NRS, and EQ-5D variables. Additionally, no significant differences in the revision and cup inclination angle were identified during the follow-up period.
This study indicated that HXLPE/Vit E liner in total hip arthroplasty may decrease the femoral head penetration, mainly due to the decreased wear in proximal directions. However, no improvement on the clinical functions and complications were identified, and whether HXLPE/Vit E has the potential to prevent implant loosening or revision surgery could not be identified, which requires to be elaborated by high-quality randomized controlled trials.
维生素E扩散的高度交联聚乙烯（HXLPE/Vit E）是全髋关节置换术（THA）中使用的一种相对先进的材料，但它是否具有优越性尚不清楚。
进行这项荟萃分析以研究HXLPE/Vit E内衬在THA中的效果。
检索Medline/PubMed、Embase和Cochrane图书馆数据库，以检索采用随机对照试验设计评估HXLPE/Vit E内衬在THA中疗效的数据。进行荟萃分析以合并感兴趣的结局估计值，如股骨头下沉（FHP）、FHP率、x轴（内侧/外侧）、y轴（垂直）和z轴（前后）方向的FHP、髋臼倾斜角、Harris髋关节评分（HHS）、数字评定量表（NRS）和并发症。然后计算随访期间不同时间点的合并结局。
在对相关数据库进行详尽检索后，23项研究共54920名参与者被认为符合本荟萃分析的条件。汇总结果显示，在最后一次随访时FHP显著降低（合并平均差[MD]=-0.10，95%置信区间[CI]：-0.14至-0.06）。亚组分析显示随访期间不同时间点存在一致趋势。术后1-2年FHP率显著降低（合并MD=-0.01，95%CI：-0.02至-0.00），而在2-5年、5-7年和7-10年未出现显著降低。临床评分的综合结果显示HHS、NRS和EQ-5D变量无显著变化。此外，随访期间在翻修和髋臼倾斜角方面未发现显著差异。
本研究表明，全髋关节置换术中的HXLPE/Vit E内衬可能会减少股骨头下沉，主要是由于近端磨损减少。然而，未发现临床功能和并发症有所改善，且无法确定HXLPE/Vit E是否有预防植入物松动或翻修手术的潜力，这需要高质量的随机对照试验进一步阐述。
