Aims: Crosslinked acetabular inserts have been introduced as a solution to the wear related periacetabular osteolysis, caused by the polyethylene wear debris. Laboratory tests and simulators have demonstrated that crosslinked-polyethylene has a higher resistance to wear than conventional polyethylene. However, studies have shown early crack or degeneration of crosslinked inserts. Concerns still remain about the clinical performances of crosslinked inserts. Although questionable, the roentgenographic measurement of the wear of the cup represents an indicator of the performance of the implant. Early catastrophic failures of other inserts taught us that for new materials it is mandatory to conduct an accurate clinical surveillance. In this work the radiographic-evaluated linear wear of a group of cross-linked inserts is compared to that of a non-crosslinked inserts for the same socket at 5 years.

Methods: From 2000 to 2002 we implanted a series of cups in which crosslinked and conventional acetabular inserts were placed randomly. Patients from each group underwent radiographic assessment after implantation, at 3 and 6 months and then yearly. Radiographs were obtained using a digitalized image system, which allowed a computerized bi-dimensional measurement by a specially developed Auto-CAD program. 12 healthy and active patients (6 crosslinke – 6 conevtional UHMWPE) have been selected for measurement.

Results: No macroscopic signs of loosening, mobilization and osteolysis were detected. Despite an increased wear rate for the conventional insert, no statistically sig-nificant differences of the linear wear were detected at five years for the two groups.

Conclusions: Longer follow-up and larger case studies are needed for more definitive conclusions. Nevertheless, this preliminary study shows that crosslinked polyethylene in vivo at 5 years does not give early failures and that its linear wear in the short term does not differ from that of a conventional polyethylene. Several other factors, such as the number and dimension of the debris, which are not detected by roentgenographic measurements, might be taken into consideration. Moreover it has been hypothesized for the crosslinked polyethylene an early plastic deformation, with consequent penetration of the head without wearing, which could affect the measurement on plan radiographs. Despite these limitations, roentgenographic measurements are quick and easy to perform, and therefore might be useful for the clinical practice of the periodical evaluation of the implants.

Aim of the study: The aim of our study is to provide a clinical and x-ray review of the Nexgen tantalum tibial plate prosthesis which have been implanted from 2004 to 2007 at our department, evaluating the short term osteointegration of the tantalum surface.

Instruments and methods: 17 Nexgen PTG have been implanted without sacrifice of the posterior ligament with tantalum tibial plateau. The tibial component is constituted by a tantalum and polythene monoblock: it is implanted a press-fit through two pegs. The evaluation has been conducted with a minimum of 12 months follow-up. We considered a total of 13 prosthesis implanted in 12. The average patients age is 59.9 years (SD of 3.5 years) and within the range 52–67 years. 77% of the prosthesis (10 prosthesis) has been implanted in female patients. In 100% of situations, the pathology at the origin of the implementation was the primary gonar-thritis. For the clinic evaluation we used the HSS scheme; for the X-ray evaluation we used the “Knee Society TKA Roentgenographic evaluation and scoring system”.

Results: clinical evaluation: the average HSS score we got at control (using the average score after 3months, 6months, 1 year and at present) is 91.7 (OS +/−7.6). The difference between the pre-surgery and at control score is about 27.6 scores. At check up every patient was free from pain with a complete operational recovery (11.19/12 scores). Nobody was using aids. The average pre-surgery articolarity was about 93 degrees, at check up we measured an average inflection extension of about 114.1 degrees. All the score differences between pre-surgery and post-surgery are statistically significant (P< =0.001). To conduct our study we used the statistical program SAS (v.8, Sas inc., North Carolina, USA). X-ray evaluation: we didn’t find any unstuck part, neither periprosthesis osteolysis nor prosthesis mobilisation. We didn’t find any periprosthesis radiolucency line bigger than 1mm and none of the previous ones had any complication at control. The absence of pain (subjective evaluation) and absence of radiolucency lines (an objective evaluation) represent two indirect parameters that we considered valid to evaluate the osteointegration of the implant.

Discussion: The improvement of the surgical technique, either technical either instrumental, associated with a lower degree of pain, let us suggest that the prosthesis implantation is indicated also in young patients with high operational demands, who need a fast and complete operational recovery. For the same reason, it’s important to guarantee a good osteointegration and a long survival of the implant, with maximum care of bond tissue, forecasting a subsequent review surgery. The features of tantalum seem to respond pretty well at these requirements, being quite similar in terms of structural characteristics to the spongious bond. The reliability of the material is assured by its use in the prosthesis surgery since a couple of years ago. The design of the prosthesis is convenient in order to save at most the bond tissue. The high friction coefficient against the bone and the physical and mechanical features of the tantalum tibial plateau guarantee a fast osteointegration of the prosthesis. Although it’s proven that the implant survival with or without cost of the posterior ligament is the same, the prosthesis without cost of the posterior ligament has been chosen because the maintenance of the patient ligament offers an intrinsic knee stability.

The optimal clinical and x-ray results, even if they are at short term, considered as indices of a good osteointe-gration, push us to believe that the use of the tantalum tibial plateau could be a good solution for any young patient with a gonarthrosis