Highly cross-linked ultra-high molecular weight polyethylene (UHMWPE) decreases wear at the hip by more than 50% compared with conventional UHMWPE. However, melted highly cross-linked polyethylene may be susceptible to fatigue cracking, and annealed highly cross-linked polyethylene may be susceptible to in vivo oxidation. The second-generation highly cross-linked UHMWPE (X3 HXPE) uses a sequential irradiation and annealing process. It preserves mechanical strength properties and has the highest survivorship in functional fatigue testing. The free radical content is low, and its performance under accelerated aging is the same as virgin UHMWPE. Hip simulator studies with 32-mm acetabular components demonstrated 97% wear reduction compared with conventional UHMWPE, and 62% compared with a clinically successful first-generation annealed highly cross-linked polyethylene. The crystallinity, density, and tensile strength of the X3 HXPE material was unchanged by oxidative challenge. X3 HXPE material articulating on cobalt-chromium alloy yields a volumetric wear rate very similar to that of metal-on-metal articulations, but eliminates the concerns of metal ion release. Wear particles generated from the X3 HXPE were the same size as those produced from conventional UHMWPE. Preliminary results suggest X3 HXPE can be used for cups larger than 36 mm.

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