Jones K, Muehlmann AM, Melvin SM, Oral E, Penrose CT. Short-term survivorship of antioxidant highly cross-linked polyethylene liners in total hip arthroplasty reported in American Joint Replacement Registry. World J Orthop 2025; 16(9): 110386 [DOI: 10.5312/wjo.v16.i9.110386]
Corresponding Author of This Article
Amber M Muehlmann, PhD, Clinical Affairs, Exactech, Inc., 2320 NW 66th Court, Gainesville, FL 32653, United States. amber.muehlmann@exac.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Sep 18, 2025; 16(9): 110386 Published online Sep 18, 2025. doi: 10.5312/wjo.v16.i9.110386
Short-term survivorship of antioxidant highly cross-linked polyethylene liners in total hip arthroplasty reported in American Joint Replacement Registry
Kirstin Jones, Amber M Muehlmann, Sarah M Melvin, Ebru Oral, Colin T Penrose
Kirstin Jones, Amber M Muehlmann, Sarah M Melvin, Clinical Affairs, Exactech, Inc., Gainesville, FL 32653, United States
Ebru Oral, Department of Orthopedic Surgery, Harvard Medical School, Boston, MA 02114, United States
Colin T Penrose, Department of Orthopaedics, Midwest Center for Joint Replacement, Indianapolis, IN 46241, United States
Author contributions: Jones K and Penrose CT designed the research study; Jones K, Muehlmann AM, and Melvin SM performed the research; Jones K, Muehlmann AM, Melvin SM, Oral E, and Penrose CT wrote the manuscript; Jones K, Muehlmann AM, Oral E, and Penrose CT edited the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: This study is exempt from Institutional Review Board approval as outlined in the US Code of Federal Regulations, 45 CFR 46.102.
Informed consent statement: This study is exempt from informed consent.
Conflict-of-interest statement: Kirstin Jones, Amber M Muehlmann, and Sarah M Melvin are paid employees of Exactech. Dr. Oral has no conflicts of interest to declare. Dr. Penrose is a paid consultant for Exactech.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Data sharing statement: No additional data are available from the authors for data sharing.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Amber M Muehlmann, PhD, Clinical Affairs, Exactech, Inc., 2320 NW 66th Court, Gainesville, FL 32653, United States. amber.muehlmann@exac.com
Received: June 7, 2025 Revised: June 30, 2025 Accepted: July 29, 2025 Published online: September 18, 2025 Processing time: 97 Days and 7.5 Hours
Abstract
BACKGROUND
Total hip arthroplasty is a safe and effective procedure. To improve survivorship, ultrahigh molecular weight polyethylene hip liners with antioxidants have been developed. Additive antioxidant was deployed to reduce oxidation and consequential wear, loosening, or osteolysis. A unique manufacturing process was utilized for two such hip liners, the Novation® and Alteon® XLE hip liners and this research represents the first large series on this specific material. The study hypothesis was that Novation and Alteon XLE hip liners have similar short-term survivorship as other manufacturers’ antioxidant liners according to procedure and outcome data from the American Joint Replacement Registry (AJRR).
AIM
To demonstrate similar short-term survivorship of XLE antioxidant hip liners compared to all antioxidant hip liners in AJRR.
METHODS
Utilizing total hip arthroplasty data from the AJRR, a retrospective review was performed for subjects who underwent implantation of Novation XLE (n = 461), Alteon XLE (n = 989), or any other antioxidant hip liner (termed the aggregate antioxidant group; n = 39964) as of March 31, 2022. Survivorship at three years and revision rates were compared statistically between the Novation group and the aggregate antioxidant group as well as the Alteon group and the aggregate antioxidant group.
RESULTS
Survivorship at three years post-surgery was 99.09% for Novation, 97.73% for Alteon, and 97.69% for the aggregate antioxidant group. There were no reports of failure due to wear in either the Novation or Alteon groups. Among the revision categories (fracture, infection, aseptic loosening, instability, mechanical complications, wear, pain, hematoma/wound complications, or other), there were no significant differences identified in either comparison. There were also no significant differences in cumulative percent revision rates up to three years post-surgery for the Novation vs aggregate antioxidant group or the Alteon vs aggregate antioxidant group.
CONCLUSION
Novation and Alteon XLE hip liner revision rate and survivorship are equivalent to other antioxidant hip liners in the short term.
Core Tip: Short-term data from the American Joint Replacement Registry on the Novation and Alteon XLE hip liners reveal similar survivorship and reasons for revision compared to an aggregate group of all other antioxidant liners. Within this dataset there were no failures due to wear in the Novation and Alteon XLE groups.
