The latest annual report from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) highlights the exceptional performance of Smith+Nephew’s proprietary OXINIUM on highly cross-linked polyethylene. The data indicates this combination has the highest survivorship rate (94.1%) among all bearing combinations over a 20-year period for total hip arthroplasty (THA).¹

The report on 20-year outcomes corroborates similar findings and peer-reviewed publications from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR).² Whitehouse et al. found that hip implants combining delta ceramic or OXINIUM (Oxidized Zirconium) heads with XLPE (highly cross-linked polyethylene) liners or cups had the lowest risk of needing revision surgery over a 15-year period.³ 

Four registries—including the Italian Registry (RIPO; Register of Orthopaedic Prosthetic Implants) and the Dutch Arthroplasty Register (LROI)—have now demonstrated that OXINIUM/XLPE had a 35% lower risk of revision at 10-years versus other modular acetabular implants.^1-5

These findings offer valuable guidance for surgeons and patients in selecting the most reliable implant materials for long-term outcomes. “When I started in practice more than 20 years ago bearing wear was the leading cause of failure of hip replacements,” said Prof. Bill Walter of The University of Sydney and Royal North Shore Hospital. “We used to see osteolysis as the main reason for revision. The AOANJRR now shows that bearing wear has been virtually eliminated as a cause of failure. The bearing combination of OXINIUM on highly cross-linked polyethylene leads the pack with revision rates at 20 years significantly lower than even metal on XLPE.” 

Through a unique manufacturing process, the OXINIUM alloy becomes a ceramicized metal—a true material transformation—rather than an applied coating.⁶ This material transformation provides OXINIUM with considerable performance benefits which include:

• Unrivalled Material Science: The durability of metal, the wear resistance of ceramic and corrosion resistance better than both metal and ceramic.^6-16
• Differentiated Composition: Virtually no nickel, cobalt and chromium,¹⁶ with a 30-fold reduction in pro-inflammatory markers for OXINIUM.^*17  As such, OXINIUM implants do not require declaration of the presence of CMR (carcinogenic, mutagenic, reprotoxic) substances on the labeling. 

“Registries throughout the world have highlighted the performance of OXINIUM for total hip arthroplasty. The AOANJRR report showing 20-year outcomes provides powerful evidence for payers, hospitals, surgeons, and patients of our truly differentiated and proven technology,” said Craig Gaffin, president of Global Orthopaedics at Smith+Nephew. “OXINIUM/XLPE continues to demonstrate superior revision rates across multiple global joint replacement registries.”

Smith+Nephew will showcase its OXINIUM Technology and hip reconstruction portfolio at the American Academy of Orthopaedic Surgeons Annual Meeting in San Diego (booth #3729), March 11-13.  

Smith+Nephew is a portfolio medical technology business focused on soft and hard tissue repair, regeneration, and replacement. Its 17,000 employees develop and apply new technologies across the company’s three global business units: Orthopaedics, Sports Medicine & ENT, and Advanced Wound Management. Founded in Hull, United Kingdom, in 1856, Smith+Nephew now operates in about 100 countries, and generated $5.8 billion in annual sales last year. Smith+Nephew is a constituent of the FTSE100 (LSE:SN, NYSE:SNN).

*     ASTM International Standard Specification for Wrought Zirconium-2.5 Niobium Alloy for Surgical Implant Applications (UNS R60901) Designation: F 2384 – 10.

References
1 Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) Hip, Knee & Shoulder Arthroplasty: 2024 Annual Report Adelaide; AOA, 2024:1–629. Available at: https://aoanjrr.sahmri.com/annual-reports-2024. Accessed Dec. 11, 2024
2 National Joint Registry for England, Wales and Northern Ireland: 21st Annual Report. 2024. Available at: NJR 21st Annual Report 2024_Hips.pdf. Accessed Jan. 06, 2025.
3 Whitehouse MR, Patel R, French JMR, et al. The association of bearing surface materials with the risk of revision following primary total hip replacement: A cohort analysis of 1,026,481 hip replacements from the National Joint Registry. PLoS Med 2024;21(11): e1004478. 
4 Peters RM, Van Steenbergen LN, Stevens M, Rijk PC, Bulstra SK, Zijlstra WP. The effect of bearing type on the outcome of total hip arthroplasty. Acta Orthop. 2018:89;163–169. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5901513/. Accessed Nov. 9, 2023.
5 Atrey A, Ancarani C, Fitch D, Bordini B. Impact of bearing couple on long-term component survivorship for primary cementless total hip replacement in a large arthroplasty registry. Poster presented at: Canadian Orthopedic Association; June 20–23, 2018; Victoria, British Columbia, Canada.
6 Hunter G, Dickinson J, Herb B, et al. Creation of oxidized zirconium orthopaedic implants. Journal of ASTM International. 2005;2:1-14.
7 Long M, Riester L, Hunter G. Nano-hardness Measurements of Oxidized Zr-2.5Nb and Various Orthopaedic Materials. Abstract presented at: 24th Annual Meeting of the Society for Biomaterials. April 22-26, 1998, San Diego, California.
8 Parikh A, Hill P, Hines G, Pawar V. Wear of conventional and highly crosslinked polyethylene liners during simulated fast walking/jogging. Poster presented at: Orthopaedic Research Society Annual Meeting; 2009; Las Vegas; NV.
9 Parikh A, Hill P, Pawar V, Sprague J. Long-term Simulator Wear Performance of an Advanced Bearing Technology for THA. Poster presented at: 2013 Annual Meeting of the Orthopaedic Research Society. Poster no. 1028.
10 Papannagari R, Hines G, Sprague J, Morrison M. Long-term wear performance of an advanced bearing technology for TKA. Poster presented at: Orthopaedic Research Society Annual Meeting; 2011; Long Beach, CA.
11 Smith+Nephew 2010. OR-10-155.
12 Aldinger P, Williams T, Woodard E. Accelerated fretting corrosion testing of zirconia toughened alumina composite ceramic and a new composition of ceramicised metal femoral heads. Poster presented at: Orthopaedic Research Society Annual Meeting; 2017; San Diego, CA.
13 Smith+Nephew 2016. OR-16-127.
14 2005 ASM International Engineering Materials Achievement Award.
15 Dalal A, Pawar V, McAllister K, Weaver C, Hallab NJ. Orthopedic implant cobalt-alloy particles produce greater toxicity and inflammatory cytokines than titanium alloy and zirconium alloy-based particles in vitro, in human osteoblasts, fibroblasts, and macrophages. J Biomed Mater Res Part A. 2012;100A:2147-2158.
16 ASTM F2384-24 (May 2024). Standard specification for wrought zirconium-2.5niobium alloy for surgical implant applications (UNS R60901). Available at: https://www.astm.org/f2384-10r16.html. Accessed Feb. 27, 2025
17 Hallab NJ, McAllister K, Jacobs JJ, and Pawar, V. Zirconium-Alloy and Zirconium-Oxide Particles Produce less Toxicity and Inflammatory Cytokines than Cobalt-Alloy and Titanium-Alloy Particles In Vitro, in Human Osteoblasts, Fibroblasts and Macrophages. 2012 Annual Meeting of the Orthopaedic Research Society. Poster no. 0971.