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Highly cross-linked UHMWPE (HXLPE) was adapted for routine use in the early 2000s to reduce the revision rates related to wear, osteolysis, and aseptic loosening resulting from conventional UHMWPE wear. Since its inception, consistent evidence showing reduced wear rates and osteolysis supports the use of HXLPE in THA. High quality studies demonstrating the advantage in long term survivorship of HXLPE over conventional UHMWPE are emerging. Though retrieval studies have demonstrated evidence of in vivo oxidation and fatigue related damage at the rim of the first generation HXLPE liners, clinical significance of this remains to be seen. Second-generation sequentially annealed and vitamin E containing HXLPE liners demonstrate improved mechanical properties, resistance to oxidation, and equivalent wear rates in comparison to their first-generation counterparts, but long term success remains to be seen.<\/jats:p>","DOI":"10.1177\/1120700018780677","type":"journal-article","created":{"date-parts":[[2018,7,12]],"date-time":"2018-07-12T07:41:48Z","timestamp":1531381308000},"page":"573-583","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":33,"title":["Manufacturing, oxidation, mechanical properties and clinical performance of highly cross-linked polyethylene in total hip arthroplasty"],"prefix":"10.1177","volume":"28","author":[{"given":"Gurpreet","family":"Singh","sequence":"first","affiliation":[{"name":"Joint Replacement Institute, London Health Science Center (LHSC), University Hospital, Schulich School of Medicine, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Klassen","sequence":"additional","affiliation":[{"name":"Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Howard","sequence":"additional","affiliation":[{"name":"Joint Replacement Institute, London Health Science Center (LHSC), University Hospital, Schulich School of Medicine, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Naudie","sequence":"additional","affiliation":[{"name":"Joint Replacement Institute, London Health Science Center (LHSC), University Hospital, Schulich School of Medicine, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Teeter","sequence":"additional","affiliation":[{"name":"Joint Replacement Institute, LHSC, University Hospital, Department of Medical Biophysics, Western University, Surgical Innovation Program, Lawson Health Research Institute, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent","family":"Lanting","sequence":"additional","affiliation":[{"name":"Joint Replacement Institute, London Health Science Center (LHSC), University Hospital, Schulich School of Medicine, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2018,7,12]]},"reference":[{"key":"bibr1-1120700018780677","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60457-7"},{"key":"bibr2-1120700018780677","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200202000-00002"},{"key":"bibr3-1120700018780677","doi-asserted-by":"publisher","DOI":"10.1002\/jor.1100170203"},{"key":"bibr4-1120700018780677","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2016.02.038"},{"key":"bibr5-1120700018780677","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-011-1872-4"},{"key":"bibr6-1120700018780677","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-014-3735-2"},{"key":"bibr7-1120700018780677","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-014-4105-9"},{"key":"bibr8-1120700018780677","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.N.00460"},{"key":"bibr9-1120700018780677","doi-asserted-by":"publisher","DOI":"10.1002\/jbm.a.10606"},{"key":"bibr10-1120700018780677","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200709000-00019"},{"key":"bibr11-1120700018780677","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200710000-00016"},{"key":"bibr12-1120700018780677","doi-asserted-by":"publisher","DOI":"10.1016\/j.biomaterials.2009.07.013"},{"key":"bibr13-1120700018780677","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2010.07.016"},{"key":"bibr14-1120700018780677","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200704000-00012"},{"key":"bibr15-1120700018780677","first-page":"1","author":"Wolford ML","year":"2015","journal-title":"NCHS Data Brief"},{"key":"bibr16-1120700018780677","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-014-4078-8"},{"key":"bibr17-1120700018780677","first-page":"1","volume-title":"UHMWPE biomaterials handbook: ultra high molecular weight polyethylene in total joint replacement and medical devices","author":"Kurtz SM","year":"2015","edition":"3"},{"key":"bibr18-1120700018780677","first-page":"7","volume-title":"UHMWPE biomaterials handbook: ultra high molecular weight polyethylene in total joint replacement and medical devices","author":"Kurtz SM","year":"2015","edition":"3"},{"key":"bibr19-1120700018780677","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmbbm.2015.08.026"},{"key":"bibr20-1120700018780677","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199407000-00020"},{"key":"bibr21-1120700018780677","doi-asserted-by":"crossref","unstructured":"Waugh W. 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