Vitamin E-infused polyethylene liners, regular polyethylene liners, and cross-linked polyethylene liners for hip replacements in adults a review of clinical effectiveness and cost effectiveness

Summary: Between 2009 and 2010, approximately 16,000 hip replacements were reported in Canada, among them, 89% were initial replacements and 11% involved revisions. Various combinations of femoral head and acetabular liner materials were used, with metal-on-plastic being the most common bearing surface (78.3%), followed by metal-on-metal (10%), ceramic-on-ceramic (7.1%), and ceramic-on-plastic (4.7%). Among metal-on-plastic surfaces, metal-on-cross-linked polyethylene occupied 71.4%, and metal-on-standard polyethylene encompassed 6.9% of the patient population. Aseptic loosening of the hip prosthesis components, which results from osteolysis secondary to bearing surface wear, is responsible for over 44% of hip revision surgery in Canada. New bearing surfaces have been developed and manufactured with the aim to improve wear properties and prolong prosthesis longevity. Among newly developed bearing surfaces, a second-generation highly cross-linked polyethylene has been developed by infusing vitamin E into the articulating surfaces of the joint prostheses. These vitamin E-infused polyethylene liners were shown to have good wear properties and improved fatigue and mechanical properties by in vitro testing. In vivo testing in rabbit knees also showed good tolerance with no adverse biological responses to vitamin E-infused polyethylene. This report aims to conduct a review of the comparative clinical effectiveness and cost-effectiveness of vitamin E infused polyethylene liners, cross-linked polyethylene liners, and regular polyethylene liners for hip replacements in adults.