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Ewen AM, Jeldi AJ, Welsh F, Picard F. No changes in bone mineral density following total knee arthroplasty using an all-polyethylene tibial component. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1057-1064. [PMID: 37907769 DOI: 10.1007/s00590-023-03762-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/06/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE Polyethylene particles produced from metal-backed tibial (MBT) implants are understood to contribute to bone loss and component loosening. This, along with advanced surgical techniques, improved materials and increasing costs, has renewed interest in all-polyethylene tibias (APTs). We investigated peri-APT bone mineral density (BMD) in patients, expecting to find no differences between two post-operative values. METHODS Patients over 65 years, with BMI ≤ 37.5 kg/m2 and no previous joint replacements were recruited to have computer-navigated total knee arthroplasty using an APT. The study cohort (n = 27) had mean age of 71.9 (SD 4.35) and BMI of 31.2 (SD 3.8). The BMD examinations were performed 6 weeks and 18 months post-operatively. Six regions of interest (ROI) were identified on anterior/posterior and lateral dual-energy X-ray absorptiometry scans. For each ROI, BMD relative differences (RDs) were determined between limbs and RDs at the two time points were compared. RESULTS No differences were found between the RDs for any ROI. No revisions or complications were reported. At 18 months post-operatively, 79.2% of the cohort were very satisfied or satisfied with the outcome of their surgery and Oxford Knee Scores improved significantly compared to pre-operatively (p < 0.001). Mean knee range of motion was 102° (SD 10.7°), and mean leg alignment was 2.0° valgus (1-6°valgus). CONCLUSION Results from BMD analysis suggest that implants were well fixated without compromising function. We believe that using APTs with computer navigation is a viable cheaper option to MBTs for patients who are less active, have lower BMI and good bone quality.
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Affiliation(s)
- Alistair M Ewen
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK.
| | - Artaban J Jeldi
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
| | - Findlay Welsh
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
| | - Frederic Picard
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
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Elmhiregh A, Abuodeh Y, Alzobi O, Zikria B, Alkhayarin M, Morrey BF. All-polyethylene versus metal-backed tibial components in total knee arthroplasty: a meta-analysis of randomized controlled trials. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3611-3622. [PMID: 37249643 PMCID: PMC10651551 DOI: 10.1007/s00590-023-03594-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 05/14/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The design of tibial trays for total knee arthroplasty (TKA) has been a topic of research for several decades. Although all-polyethylene trays were developed to address issues such as osteolysis and to enhance the longevity of the prosthesis, as well as knee range of motion, metal-backed designs have remained the most commonly used type of prosthesis. This meta-analysis aimed to compare the clinical, radiological, and survival outcomes of both designs. METHODS Five databases were searched from inception until October 1, 2020, for randomized controlled trials (RCTs) that compared the outcomes of all-polyethylene and metal-backed tibial components in TKA. The outcomes of interest included range of motion, knee society score, stairs climbing scores, radiostereographic analysis, survivorship and complication. This review was conducted in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias was assessed using the Newcastle-Ottawa tool. RESULTS A total of 14 RCTs with 1367 TKA were included with a mean age of - years and - years for all-polyethylene and metal-backed tibial components groups, respectively. All-polyethylene group demonstrated statistically significant differences in five-year survivorship (OR 0.27; 95% CI 0.10-0.75; p value 0.01) and stairs climbing score (OR - 2.07; 95% CI - 3.27-0.87; p value 0.0007) when compared to the metal-backed group. The metal-backed design was significantly more radiographically stable in anterior-posterior, varus-valgus, and internal-external rotations at the 2-year follow-up compared to all-polyethylene tibias (OR - 0.09; 95% CI - 0.16 to - 0.02; p value 0.02) as per the pooled radiostereographic analysis. However, ten-year survivorship (OR 0.92; 95% CI 0.53-1.60; p value 0.78), range of motion (OR - 0.57; 95% CI - 2.00-0.85, p value 0.43), knee society scores (OR 1.38; 95% CI - 0.47-3.23, p value 0.14), and complications (OR 0.83; 95% CI 0.5-1.39, p value 0.48) were comparable between both groups. CONCLUSIONS While this meta-analysis suggests that all-polyethylene tibial components in total knee arthroplasty may offer advantages over metal-backed components in terms of five-year survivorship, and stairs climbing score, this finding should be considered in the context of potential confounding factors. Nonetheless, based on the results, the all-polyethylene implant should be considered a viable choice for primary knee replacement. LEVEL OF EVIDENCE I.
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Affiliation(s)
| | - Yousef Abuodeh
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Osama Alzobi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
| | - Bashir Zikria
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Mohd Alkhayarin
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
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Killen CJ, Murphy MP, Hopkinson WJ, Harrington MA, Adams WH, Rees HW. Minimum twelve-year follow-up of fixed- vs mobile-bearing total knee arthroplasty: Double blinded randomized trial. J Clin Orthop Trauma 2020; 11:154-159. [PMID: 32002005 PMCID: PMC6985168 DOI: 10.1016/j.jcot.2019.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) with fixed-bearing (FB) implants have demonstrated impressive functional results and survival rates. Meanwhile, rotating-platform (RP) constructs have biomechanically shown to reduce polyethylene wear, lower the risk of component loosening, and better replicate anatomic knee motion. There is growing question of the clinical impact these design changes have long-term.Questions/purposes: The aim of this double-blinded prospective randomized trial was to compare function and implant survival in patients who received either FB or RP press-fit condylar Sigma (PFC Sigma, DePuy, Warsaw, IN) total knee replacements at a minimum follow-up of twelve years. PATIENTS AND METHODS Patient reported outcome measures used included the functional Knee Society Score, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores, Medical Outcomes Short Form-36 (SF-36) score, and satisfaction assessment on a four-point Likert scale. The data was collected from times preoperative, two-years, and final encounter (mean 13.95 years). A total of 28 RP and 19 FB knees (58.8%) were analyzed at the final follow-up. RESULTS Among all patients, KSS and WOMAC scores statistically improved from pre-op to 2-year, while KSS statistically worsened from 2-year to final follow-up. The RP group averaged better follow-up scores in all assessments at the final follow-up with exception of overall satisfaction. There was no statistically significant difference in the functional Knee Society Score, Short Form-36, WOMAC scores, patient satisfaction or implant survival between the two groups at any measured period. CONCLUSIONS The use of a fixed-bearing or rotating-platform design does not convey significant superiority in terms of function or implant longevity at a minimum twelve years after total knee arthroplasty. LEVEL OF EVIDENCE Level I, Experimental study, randomized controlled trial (RCT).
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Affiliation(s)
- Cameron J. Killen
- Loyola University Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 2160 S. First Avenue, Maguire Suite 1700, Maywood, IL, 60153, USA
| | - Michael P. Murphy
- Loyola University Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 2160 S. First Avenue, Maguire Suite 1700, Maywood, IL, 60153, USA,Corresponding author.
| | - William J. Hopkinson
- Loyola University Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 2160 S. First Avenue, Maguire Suite 1700, Maywood, IL, 60153, USA
| | - Melvyn A. Harrington
- Baylor College of Medicine, Department of Orthopaedic Surgery and Rehabilitation, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - William H. Adams
- Loyola University Medical Center, Department of Clinical Research, 2160 S. First Avenue, Maguire Suite 1700, Maywood, IL, 60153, USA
| | - Harold W. Rees
- Loyola University Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 2160 S. First Avenue, Maguire Suite 1700, Maywood, IL, 60153, USA
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Hasan S, Marang-Van De Mheen PJ, Kaptein BL, Nelissen RGHH, Toksvig-Larsen S. All-polyethylene versus metal-backed posterior stabilized total knee arthroplasty: similar 2-year results of a randomized radiostereometric analysis study. Acta Orthop 2019; 90:590-595. [PMID: 31550947 PMCID: PMC6844393 DOI: 10.1080/17453674.2019.1668602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The all-polyethylene tibial (APT) component, introduced in the early 1970s, was surpassed by metal-backed tibial (MBT) trays as the first choice for total knee arthroplasty (TKA). With improved polyethylene, the modern APT components can reduce costs, and have shown equivalent results in survivorship and early migration of the cruciate-retaining and cruciate-stabilizing designs. This study compares the 2-year migration of a similarly designed APT-posterior stabilized (PS) and a MBT-PS TKA, using radiostereometric analysis (RSA).Patients and methods - 60 patients were randomized to receive either an APT Triathlon PS or an MBT Triathlon PS TKA (Stryker, NJ, USA). Migration measured by RSA and clinical scores were evaluated at baseline and at 3, 12, and 24 months postoperatively. Repeated measurements were analyzed with a linear mixed model and generalized estimating equations.Results - The mean maximum total point movement (MTPM) at 3, 12, and 24 months was 0.41 mm (95% CI 0.33-0.50), 0.57 mm (0.44-0.70), and 0.56 mm (0.42-0.69) respectively in the MBT group and 0.46 mm (0.36-0.57), 0.61 mm (0.49-0.73), and 0.64 mm (0.50-0.77) in the APT group. 2 MBT and 1 APT implant were considered unstable at the 2-year follow-up. The KSS Knee score and KSS Function across 3, 12, and 24 months were comparable in both groups.Interpretation - For an APT-PS designed component, MTPM measured with RSA is comparable to the MBT-PS component after 2 years of follow-up. No differences in complications or clinical outcomes were found.
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Affiliation(s)
- Shaho Hasan
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands; ,Correspondence:
| | | | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands;
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands;
| | - Sören Toksvig-Larsen
- Department of Orthopaedics, Hässleholm Hospital, Hässleholm, Sweden and Department of Clinical Sciences, Lund University, Lund, Sweden
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All-polyethylene versus metal-backed tibial component in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:3620-3636. [PMID: 27209191 DOI: 10.1007/s00167-016-4168-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/10/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE The aim of this systematic review was to evaluate the clinical outcomes, rate of revisions and complications of all-polyethylene tibial and metal-backed tibial components in patients treated with knee arthroplasty for primary or secondary osteoarthritis. METHODS A systematic review of the literature according to the PRISMA guidelines was performed. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the keywords such as "knee", "arthroplasty", "metal-backed", and "all-polyethylene", since inception of databases to 2016, was performed. RESULTS Thirty-two articles, describing patients with all-polyethylene tibial or metal-backed tibial components in the setting of osteoarthritis, were included. A total of 68,202 knees in 58,942 patients were included, with an average age at surgery of 69.3 years, ranging from a mean age of 57.9-82 years. The mean KSS was 82.4 and 81.3 (n.s.), the mean KSS(F) was 73.6 and 74.9 (p = 0.04), the mean ROM was 104.5 and 104.6 (n.s.), and the mean HSS was 87 and 86, each, respectively, for the metal-backed tibial components group and all-polyethylene tibial components group. The overall rate of revisions was 1.90 %. The rate of revision in the metal-backed tibial components group was 1.85 %, whilst the rate of revision in the all-polyethylene tibial components group was 2.02 % (p < 0.00001). CONCLUSION Metal-backed tibial and all-polyethylene tibial components did not show any significant difference in most of the included outcome scores, but statistical differences were found in terms of complications and revision rate. These items have a negative impact on the cost-effectiveness of all-polyethylene tibial components. Even if all-polyethylene tibial components show similar clinical outcome score, equivalent range of knee motion, and long-term survival compared to metal-backed tibial components, complications and revision rate seem to lead the surgeon to prefer the last ones. The clinical relevance of this study is that metal-backed tibial components should be preferred in TKA surgery because complications are higher using all-polyethylene tibial components. On the other hand, the quality of evidence, according to GRADE system, is low underling the necessity of more randomised study to clarify these items. LEVEL OF EVIDENCE III.
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Thompson SM, Yohuno D, Bradley WN, Crocombe AD. Finite element analysis: a comparison of an all-polyethylene tibial implant and its metal-backed equivalent. Knee Surg Sports Traumatol Arthrosc 2016; 24:2560-6. [PMID: 26694487 DOI: 10.1007/s00167-015-3923-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/10/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE The hypothesis of this study is that all-polyethylene (APE) tibial implants offer a biomechanical profile similar to metal-backed tray (MBT). There are significant financial implications, in selected patient groups, if APE can be deemed to perform as well as MBT. METHODS Using a finite element analysis of CAD models provided by DePuy (Leeds), stress distributions were investigated for both an APE and MBT tibial implant. The performance was assessed for cancellous bone at 700 MPa (normal) and at 350 MPa (less stiff). Plots were recorded along the length of the tibia, showing the loads carried by the bone (cortical and cancellous), the implant interface, cement interface and the stem. von Mises stress distributions and percentage volumes were used to assess bone resorption and hence potential for failure (fracture). RESULTS Higher stress shielding (resorption) occurred around the keel and stem of the MBT revealing greater potential for bone loss in these areas. APE had no areas of bone resorption (being more flexible resulting in less stress shielding). The stiffer MBT carries a higher proportion of the load down the stem. MBT stress in cancellous bone is lower than APE, as load is distributed to the cortical rim. APE has a marginally favourable strain state in cancellous bone and spreads loads more at the cement interface than MBT. CONCLUSION Modern-day APE bearings may be superior to previously designed implants due to improvements in manufacturing. In the correct patient group, this could offer substantial cost savings.
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Affiliation(s)
| | - D Yohuno
- Department of Mechanical Engineering, University of Surrey, Guildford, UK
| | - W N Bradley
- Royal Surrey County Hospital, Egerton Rd, Surrey, GU2 7XX, UK
| | - A D Crocombe
- Department of Mechanical Engineering, University of Surrey, Guildford, UK
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Maradit Kremers H, Kremers WK, Sierra RJ, Lewallen DG, Berry DJ. Competing Risk of Death When Comparing Tibial Implant Types in Total Knee Arthroplasty. J Bone Joint Surg Am 2016; 98:591-6. [PMID: 27053588 DOI: 10.2106/jbjs.15.00488] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In the presence of a competing risk of death, the Kaplan-Meier method is known to overestimate the probability of implant failure. To our knowledge, the magnitude of the competing risk of death in survivorship analyses in total knee arthroplasty has not been studied. The purpose of this study was to determine the extent of the competing risk of death in different age groups during a long-term follow-up of patients who had undergone primary total knee arthroplasty. METHODS The study population comprised 22,864 primary total knee arthroplasties at a large medical center in the United States. We compared the overall revision outcomes estimated using the Kaplan-Meier method and the cumulative incidence function over a mean follow-up of 7.8 years (range, 0.1 to 26.3 years). RESULTS The risk of death exceeded the risk of revision by a factor of 4 at twelve years following the surgical procedure. The Kaplan-Meier method overestimated the risk of revision by 3% at five years, 14% at ten years, 32% at fifteen years, and 57% at twenty years. At ten years after the surgical procedure, the risk of death exceeded the risk of revision by a factor of 15 in the all-polyethylene group and by a factor of 3.5 in the metal modular group. The Kaplan-Meier method overestimated the ten-year risk of revision by 18% in the all-polyethylene group and by 11% in the metal modular group. After accounting for the higher competing risk of death in the all-polyethylene group, the cumulative incidence of revision in the metal modular group was about 2.5 to three times higher than that in the all-polyethylene group at ten years. CONCLUSIONS Although the Kaplan-Meier and cumulative incidence methods yielded different implant survival estimates beyond ten years (Kaplan-Meier overestimates implant failure), the size of the bias was small at earlier time points. The extent of overestimation depends on the duration of follow-up and the magnitude of the competing risk of death. CLINICAL RELEVANCE This study examines the clinical relevance of the competing risk of death in total knee arthroplasty.
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Affiliation(s)
- Hilal Maradit Kremers
- Departments of Health Sciences Research (H.M.K and W.K.K.) and Orthopedic Surgery (H.M.K., R.J.S., D.G.L., and D.J.B.), Mayo Clinic, Rochester, Minnesota
| | - Walter K Kremers
- Departments of Health Sciences Research (H.M.K and W.K.K.) and Orthopedic Surgery (H.M.K., R.J.S., D.G.L., and D.J.B.), Mayo Clinic, Rochester, Minnesota
| | - Rafael J Sierra
- Departments of Health Sciences Research (H.M.K and W.K.K.) and Orthopedic Surgery (H.M.K., R.J.S., D.G.L., and D.J.B.), Mayo Clinic, Rochester, Minnesota
| | - David G Lewallen
- Departments of Health Sciences Research (H.M.K and W.K.K.) and Orthopedic Surgery (H.M.K., R.J.S., D.G.L., and D.J.B.), Mayo Clinic, Rochester, Minnesota
| | - Daniel J Berry
- Departments of Health Sciences Research (H.M.K and W.K.K.) and Orthopedic Surgery (H.M.K., R.J.S., D.G.L., and D.J.B.), Mayo Clinic, Rochester, Minnesota
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Zambianchi F, Digennaro V, Giorgini A, Grandi G, Fiacchi F, Mugnai R, Catani F. Surgeon's experience influences UKA survivorship: a comparative study between all-poly and metal back designs. Knee Surg Sports Traumatol Arthrosc 2015; 23:2074-80. [PMID: 24682516 DOI: 10.1007/s00167-014-2958-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 03/13/2014] [Indexed: 01/31/2023]
Abstract
PURPOSE Concerns exist regarding prosthetic positioning and post-operative limb alignment in unicompartmental knee arthroplasty (UKA). In this study, we hypothesized deviations of the post-op anatomical femoro-tibial angle (aFTA) and the tibial component alignment to be factors influencing UKA survivorship. Moreover, by a comparison between all-poly and metal back UKAs, we hypothesized that prosthetic design plays a role in implant survivorship. METHODS One hundred ninety-five medial UKAs were performed on 176 patients by two experienced surgeons and one low-UKA user. One hundred and forty-seven UKAs were included in the study: 72 all-poly and 75 metal back. Measurements were performed on radiographs: mechanical femoro-tibial angle, Cartier angle, aFTA and tibial posterior slope (PS) on pre-op radiographs; femoral and tibial component varus/valgus, aFTA and tibial component PS on post-op radiographs. RESULTS At an average follow-up of 61 months (min. 30, max. 107), 147 UKAs were evaluated: The reported survivorship rate was 93.1 %. Eleven implants underwent revision: ten all-poly and one metal back. No differences were reported between the two groups in the radiographic measurements. Significant radiographic differences were reported between revised and not revised UKAs: Revised UKAs were associated with overcorrection of the pre-op Cartier angle and under correction of pre-op aFTA. Most of revised UKAs were performed by the low-volume UKA surgeon. CONCLUSIONS Surgeon's experience is essential to achieve good results in UKA: Preserving the tibial epiphyseal axis and avoiding excessive or insufficient corrections of the pre-operative limb alignment are predictor of successful replacement, while prosthetic designs, models and fixation geometry do not affect UKA outcome. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- F Zambianchi
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio-Emilia, Via del Pozzo 71, 41124, Modena, Italy,
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In vitro effects on mobile polyethylene insert under highly demanding daily activities: stair climbing. INTERNATIONAL ORTHOPAEDICS 2014; 39:1433-40. [DOI: 10.1007/s00264-014-2622-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/26/2014] [Indexed: 12/12/2022]
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Kremers HM, Sierra RJ, Schleck CD, Berry DJ, Cabanela ME, Hanssen AD, Pagnano MW, Trousdale RT, Lewallen DG. Comparative Survivorship of Different Tibial Designs in Primary Total Knee Arthroplasty. J Bone Joint Surg Am 2014; 96:e121. [PMID: 25031383 DOI: 10.2106/jbjs.m.00820] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few registry-based studies in the United States have compared the survivorship of different knee implant designs in total knee arthroplasty. The purpose of this study was to compare differences in survivorship of commonly used tibial implant designs in primary total knee arthroplasty. METHODS A total of 16,584 primary total knee arthroplasties in 11,992 patients were performed at a single institution from 1985 to 2005. Patients were prospectively followed at regular intervals to ascertain details of subsequent revisions. Overall revision rates and revisions for aseptic loosening, wear, and osteolysis were compared across twenty-two tibial implant designs using Cox proportional hazards regression models adjusting for age, sex, calendar year, and body mass index. RESULTS In comparison with metal-backed modular implants, all-polyethylene tibial components had a significantly lower risk of revision (hazard ratio, 0.3; 95% confidence intervals: 0.2, 0.5 [p < 0.0001]). The risk reduction with all-polyethylene tibial components was not affected by age, sex, or body mass index. With metal-backed modular tibial designs, cruciate-retaining knees performed better than the posterior-stabilized knees (p = 0.002), but this finding was limited to one specific metal-backed modular tibial component, the Press Fit Condylar design. With all-polyethylene tibial components, there was no survivorship difference between cruciate-retaining and posterior-stabilized designs. CONCLUSIONS All-polyethylene tibial components were associated with better outcomes than metal-backed modular components. Cruciate-retaining and posterior-stabilized designs performed equally well, except with the Press Fit Condylar design. Obese patients may have superior results with all-polyethylene and posterior-stabilized components. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hilal Maradit Kremers
- Departments of Health Sciences Research (H.M.K. and C.D.S.) and Orthopedic Surgery (R.J.S., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address for H.M. Kremers:
| | - Rafael J Sierra
- Departments of Health Sciences Research (H.M.K. and C.D.S.) and Orthopedic Surgery (R.J.S., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address for H.M. Kremers:
| | - Cathy D Schleck
- Departments of Health Sciences Research (H.M.K. and C.D.S.) and Orthopedic Surgery (R.J.S., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address for H.M. Kremers:
| | - Daniel J Berry
- Departments of Health Sciences Research (H.M.K. and C.D.S.) and Orthopedic Surgery (R.J.S., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address for H.M. Kremers:
| | - Miguel E Cabanela
- Departments of Health Sciences Research (H.M.K. and C.D.S.) and Orthopedic Surgery (R.J.S., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address for H.M. Kremers:
| | - Arlen D Hanssen
- Departments of Health Sciences Research (H.M.K. and C.D.S.) and Orthopedic Surgery (R.J.S., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address for H.M. Kremers:
| | - Mark W Pagnano
- Departments of Health Sciences Research (H.M.K. and C.D.S.) and Orthopedic Surgery (R.J.S., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address for H.M. Kremers:
| | - Robert T Trousdale
- Departments of Health Sciences Research (H.M.K. and C.D.S.) and Orthopedic Surgery (R.J.S., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address for H.M. Kremers:
| | - David G Lewallen
- Departments of Health Sciences Research (H.M.K. and C.D.S.) and Orthopedic Surgery (R.J.S., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address for H.M. Kremers:
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