Polyethylene Oxidation in Total Hip Arthroplasty: Evolution and New Advances

Enrique Gómez-Barrena*, 1, Francisco Medel2, José Antonio Puértolas3
1 Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
2 Materials Science and Technology Department-Instituto Ciencia de Materiales de Aragón, Universidad de Zaragoza-CSIC, Spain
3 Materials Science and Technology Department-I3A, Instituto Ciencia de Materiales de Aragón, Universidad de Zaragoza-CSIC, Spain

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© Gómez-Barrena et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Servicio de Cirugía Ortopédica y Traumatología, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Avda Reyes Católicos 2, Madrid 28040, Spain; Tel: +34.915504827; Fax: +34.915431071; E-mail:


Ultra-high molecular weight polyethylene (UHMWPE) remains the gold standard acetabular bearing material for hip arthroplasty. Its successful performance has shown consistent results and survivorship in total hip replacement (THR) above 85% after 15 years, with different patients, surgeons, or designs.

As THR results have been challenged by wear, oxidation, and liner fracture, relevant research on the material properties in the past decade has led to the development and clinical introduction of highly crosslinked polyethylenes (HXLPE). More stress on the bearing (more active, overweighted, younger patients), and more variability in the implantation technique in different small and large Hospitals may further compromise the clinical performance for many patients. The long-term in vivo performance of these materials remains to be proven. Clinical and retrieval studies after more than 5 years of in vivo use with HXLPE in THR are reviewed and consistently show a substantial decrease in wear rate. Moreover, a second generation of improved polyethylenes is backed by in vitro data and awaits more clinical experience to confirm the experimental improvements. Also, new antioxidant, free radical scavengers, candidates and the reinforcement of polyethylene through composites are currently under basic research.

Oxidation of polyethylene is today significantly reduced by present formulations, and this forgiving, affordable, and wellknown material is still reliable to meet today’s higher requirements in total hip replacement.

Keywords: UHMWPE, HXLPE, cross-linked polyethylene, polyethylene, oxidation, total hip arthroplasty.