Does the presence of a lipped highly crosslinked polyethylene liner affect the survival of total hip arthroplasty implants?

Listen to Simon and Amy discuss the paper 'Does the presence of a lipped highly crosslinked polyethylene liner affect the survival of total hip arthroplasty implants?' published in the January 2026 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome to another episode of AI Talks with Bone & Joint from the publishers of Bone & Joint Open. Today we're discussing the paper titled, 'Does the presence of a lipped highly crosslinked polyethylene liner affect the survival of total hip arthroplasty implants?', published in January 2026. I'm Simon, and I'm joined by my co-host, Amy.

Hello Simon, delighted to be here. This paper authored by Alberto Di Martino and colleagues from the Rizzoli Orthopaedic Institute in University of Bologna in Italy explores a vital aspect of total hip arthroplasty or THA often lauded as the operation of the century.

THA has been remarkably successful, but with the increasing number of these procedures, there's also a predicted rise in revision surgeries. The central question here is whether using a lip highly crosslinked polyethylene liner affects the long-term survival of these implants compared to flat liners.

To investigate this, the researchers performed a large-scale analysis using data from the Emilia-Romagna Registry of [00:01:00] Orthopaedic Prosthetic Implants, or RIPO encompassing 15,222 primary THAs done between the year 2021.

They employed rigorous statistical methods such as Kaplan-Meier survival analysis and multivariate Cox regression. What stands out is that they divided the patients into two groups, those with flat liners and those with lipped liners. The primary focus was on implant survival, especially concerning mechanical complications like dislocation and aseptic loosening.

The findings were quite revealing. Overall, there wasn't a significant difference in revision rates between the two groups when considering all causes. However, focusing on mechanical complications, the lipped liners exhibited higher rates of problems. The use of lipped liners was associated with an increased hazard of revision of 1.53.

Yes, specifically the lipped liner group had a higher incidence of revisions due to dislocation and aseptic loosening of the acetabular component. At the 15-year [00:02:00] mark, implant survival was 96.9% for flat liners and 96.4% for lipped liners. Yet when looking solely at mechanical failure, the difference was more pronounced at 20 years. With flat liners showing 98.9% survival compared to 96.2% for lipped liners.

It's crucial to highlight that the study also established that improper orientation of these lipped liners could lead to impingement and accelerated wear, contributing to the higher mechanical failures. In summary, while lipped liners theoretically provide better stability by increasing the jump distance needed for dislocation their actual performance in real world long-term cases seems to introduce more mechanical issues.

Exactly. Simon. The key point is that the use of lipped liners should be handled carefully. Their advantages heavily rely on precise surgical placement and patient-specific anatomical factors. Surgeons must be meticulous in deciding if a lipped liner is suitable, balancing the potential for added stability against the risks of mechanical complications, [00:03:00] such as dislocation and polyethylene wear.

It's evident that advancements in THA, like the development of highly crosslinked polyethylene liners are pivotal. But ongoing evaluation and refinement of these technologies are essential to optimize patient outcomes.

Absolutely, thank you for listening to AI Talks with Bone & Joint. To explore this study further, do check out the full paper in Bone & Joint Open.

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