Minimum 10-Year Outcomes of Total Hip Arthroplasty with Highly Cross-Linked Polyethylene in Patients Under 50 Years: A Systematic Review and Meta-Analysis.

Abstract

Total hip arthroplasty (THA) is increasing in utilization among young patients. While THA markedly improves outcomes in those who have degenerative hip disease, patients under 50 years face an extended lifetime risk for complications and revisions. Highly cross-linked polyethylene (HXLPE) is associated with reduced wear, revision rates, and osteolysis compared to conventional polyethylene, potentially enhancing implant longevity in this younger, active population. This study systematically reviewed and meta-analyzed the outcomes of THA using HXLPE in patients under 50 years of age at a minimum 10-year follow-up. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Searches were performed in Embase, Ovid Medline, Scopus, and Cochrane databases. Inclusion criteria targeted studies with patients under 50 years reporting original data on THA using HXLPE with a mean follow-up of ≥ 10 years. Data extraction was performed independently by two reviewers, and study quality was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Multiple random-effects meta-analyses were performed to summarize outcomes. There were eighteen studies included (n = 1,587 hips) with a weighted mean follow-up of 14.1 years. Overall, revision-free survivorship was 98%, and the weighted mean improvement in Harris Hip Score was 43.7 points. A random-effects meta-analysis yielded a pooled linear wear rate of 0.024 mm/year (95% confidence interval (CI): 0.013 to 0.035). All wear rates remained well below the 0.1 mm/year threshold associated with osteolysis risk, regardless of femoral bearing material or size. Total hip arthroplasty using highly cross-linked polyethylene in patients aged ≤ 50 years yields excellent clinical and radiographic outcomes with minimal wear observed up to 20 years postoperatively. Importantly, these benefits are largely maintained regardless of the femoral head bearing material or size. These findings support the continued use of HXLPE among young patients to maximize wear parameters and revision-free survival.