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Van Meirhaeghe JP, Harris IA, Cuthbert A, Lorimer M, McAuliffe M, Adie S, Molnar R. The influence of implant factors on patient outcomes in primary total knee arthroplasty. J Orthop 2024; 58:154-160. [PMID: 39157416 PMCID: PMC11326491 DOI: 10.1016/j.jor.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/15/2024] [Indexed: 08/20/2024] Open
Abstract
Background The influence of implant factors on patient-reported outcome measures (PROMS) after total knee arthroplasty (TKA) has previously been studied but findings are often inconsistent, restricted in scope and biased by confounding factors. This study aims to determine the association between implant-related factors and early post-operative PROMs after TKA. Methods Using data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) PROMs program, the study included 9487 primary TKA procedures performed in 43 hospitals from July 31, 2018 to December 31, 2020. Data included baseline demographic data, surgical details and PROMs collected pre- and 6 months post-operatively. Seven prosthesis characteristics were incorporated in the multivariable model, with proportional odds ordinal regression analysis used to assess their effects on post-operative Oxford knee score (OKS) and joint pain. Adjustments were made for pre-operative OKS and joint pain, as well as potential patient confounders. Results At six months, fixed bearing implants showed higher odds of better OKS compared to mobile bearing implants (odds ratio [OR] = 1.20, 95 % confidence interval [CI] 1.06-1.37. p < 0.004). Similar findings were found with the use of image derived instrumentation (IDI) (OR = 1.27, 95 % CI 1.11-1.46, p < 0.001), robotic assisted vs. non-navigated knees (OR = 1.21, 95 % CI 1.06-1.38, p < 0.005) and no patella resurfacing (OR = 1.10, 95 % CI 1.01-1.20, p < 0.032). For lower pain scores at six months, the use of highly crosslinked polyethylene (OR = 1.12, 95 % CI 1.02-1.22, p < 0.015), cemented femoral components (OR = 1.11, 95 % CI 1.01-1.22, p < 0.024), IDI (OR = 1.20, 95 % CI 1.05-1.37, p < 0.009) or no patella resurfacing (OR = 1.10, 95 % CI 1.01-1.20, p < 0.034) were associated. Conclusion Utilizing a fixed bearing or robotic assistance correlated with improved OKS scores, whereas highly crosslinked polyethylene or cemented femoral components were associated with improved pain scores. At six months, the use of IDI compared to non-navigated TKA, and patellar resurfacing showed both improved OKS and pain scores.
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Affiliation(s)
- Jan Peter Van Meirhaeghe
- Sydney Orthopaedic Trauma and Reconstructive Surgery (SOTRS), Sydney, Australia
- Department of Orthopaedics, University Hospital of Ghent, Ghent, Belgium
| | - Ian A. Harris
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Australia
| | - Alana Cuthbert
- South Australian Health & Medical Research Institute (SAHMRI), Australia
| | - Michelle Lorimer
- South Australian Health & Medical Research Institute (SAHMRI), Australia
| | - Michael McAuliffe
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Australia
- Queensland University of Technology (QUT - Gardens Point), Australia
| | - Sam Adie
- St. George and Sutherland Hospitals, Sydney, Australia
- St. George and Sutherland Clinical School, UNSW, Australia
| | - Robert Molnar
- St. George and Sutherland Hospitals, Sydney, Australia
- St. George and Sutherland Clinical School, UNSW, Australia
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Cheng R, Kim B, Taylor WL, Westrich GH, Shen TS. Robotic-assisted total knee arthroplasty is associated with the use of thinner polyethylene liners compared to navigation-guided and manual techniques. Knee Surg Sports Traumatol Arthrosc 2024; 32:2290-2296. [PMID: 38738862 DOI: 10.1002/ksa.12228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE The purpose of this study was to examine the effects of intraoperative technology use on the rate of using polyethylene liners 15 mm or greater during primary total knee arthroplasty (TKA). METHODS There were 103,295 implants from 16,386 primary unilateral TKAs performed on 14,253 patients at a single institution between 1 January 2018, and 30 June 2022, included in the current study. Robotic assistance and navigation guidance were used in 1274 (8%) and 8345 (51%) procedures, respectively. The remaining 6767 TKAs (41%) were performed manually. Polyethylene liners were manually identified and further subcategorised by implant thickness. Patients who underwent robotic-assisted TKA were younger (p < 0.001) and more likely to be male (p < 0.001) compared to patients who underwent navigation-guided or manual TKAs. RESULTS Average polyethylene liner thickness was similar between groups (10.5 ± 1.5 mm for robotic-assisted TKAs, 10.9 ± 1.8 mm for navigation-guided TKAs and 10.8 ± 1.8 mm for manual TKAs). The proportions of polyethylene liners 15 mm or greater used were 4.9%, 3.8% and 1.9% for navigation-guided, manual and robotic-assisted procedures, respectively (p < 0.001). Multivariate regression analyses demonstrated that navigation-guided (odds ratio [OR]: 2.6, 95% confidence Interval [CI]: [1.75-4.07], p < 0.001) and manual (OR: 2.0, 95% CI: [1.34-3.20], p = 0.001) procedures were associated with an increased use of polyethylene liners 15 mm or greater. CONCLUSION Robotic-assisted TKA was associated with a lower proportion of polyethylene liners 15 mm or greater used compared to navigation-guided and manual TKA. These findings suggest that robotic assistance can reduce human error via a more precise cutting system, limit over-resection of the tibia and flexion-extension gap mismatch and ultimately allow for more appropriately sized implants. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Ryan Cheng
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Billy Kim
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Walter L Taylor
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Geoffrey H Westrich
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Tony S Shen
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
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Yao K, Chen Y. Comprehensive evaluation of risk factors for aseptic loosening in cemented total knee arthroplasty: A systematic review and meta-analysis. J Exp Orthop 2024; 11:e12095. [PMID: 39035847 PMCID: PMC11260281 DOI: 10.1002/jeo2.12095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/03/2024] [Indexed: 07/23/2024] Open
Abstract
Purpose Aseptic loosening is the most common cause for revisions after total knee arthroplasty (TKA). Despite many studies exploring various risk factors associated with aseptic loosening, findings often present inconsistencies. To address this, we conducted a thorough review of the literature to identify and analyse these risk factors in cemented TKA. Additionally, we performed a meta-analysis to reconcile the divergent conclusions observed across studies. Methods We searched PubMed, Web of Science and Embase from 1996 up to 2024 and evaluated the quality of the included literature. Seventy-four studies were included to assess the association of BMI, diabetes, high physical activity (HPA), osteoporosis, rheumatoid arthritis (RA), cement material and implant design. Twenty-nine studies were used to calculate relative risk and CIs (using the random effects theory) and study heterogeneity for six different risk factors (BMI, diabetes, HPA level, cement material, polyethylene and implant design). Results Patients with diabetes are eight times more likely to experience aseptic loosening compared to those without diabetes (RR = 9.18, 95% CI: 1.80-46.77, p < 0.01). The use of tibial stem extension or highly crosslinked polyethylene can help reduce the incidence of aseptic loosening. However, we did not identify BMI, HPA, osteoporosis, RA, the use of high-viscosity cement and the utilization of mobile-bearing designs as risk factors for aseptic loosening post-cemented TKA. Conclusions Patients with diabetes undergoing TKA should be counselled regarding their potential increased risk of aseptic loosening. The use of tibial stem extensions and HXLPE can mitigate the incidence of aseptic loosening in cemented TKA. However, given a limited number of studies were included in the meta-analysis, we believe that higher-level studies are necessary to clearly identify other risk factors. Level of Evidence Level III.
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Affiliation(s)
- Kaiyi Yao
- Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
| | - Yao Chen
- Department of Applied Mathematics, Computer Science and StatisticsGhent UniversityGhentBelgium
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and NutritionGhent UniversityMerelbekeBelgium
- DIGPCR‐Ghent University Digital PCR ConsortiumGhent UniversityMerelbekeBelgium
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Zhou Y, Rele S, Elsewaisy O. Does the use of tibial stem extensions reduce the risk of aseptic loosening in obese patients undergoing primary total knee arthroplasty: A systematic review and meta-analysis. Knee 2024; 48:35-45. [PMID: 38492539 DOI: 10.1016/j.knee.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 12/27/2023] [Accepted: 02/26/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND This study aimed to compare the risk of revision for aseptic loosening in obese (body mass index >30 kg/m2) patients with stemmed (ST) versus non-stemmed (NST) tibial implants in primary total knee arthroplasty (TKA). METHODS A systematic review and meta-analysis were conducted following PRISMA and MOOSE guidelines. Studies reporting a direct comparison between ST and NST tibial implants in obese patients were included. The primary outcome of interest was revision for aseptic loosening. Outcomes were analysed using meta-analysis of relative risk. Risk of bias assessment was performed using the Newcastle-Ottawa Scale for observational studies and the RoB-2 Cochrane tool for randomised studies. RESULTS Seven studies met the selection criteria, consisting of four cohort studies and three randomised controlled trials. Mean follow up time for the eligible cohort was 62.6 months. Meta-analysis demonstrated a statistically significant reduction in the risk of aseptic revision in the ST group compared with the NST group (risk ratio 0.25, 95% confidence interval 0.07 to 0.92). After removal of all zero-event studies, the results remained in favour of the ST group (risk ratio 0.15, 95% confidence interval 0.03 to 0.64). CONCLUSIONS This study found that obese patients undergoing TKA with stemmed tibial implants may have a lower risk of aseptic revision compared with those with non-stemmed tibial implants. However, due to the lack of high-quality literature available, our study is unable to draw a definitive conclusion on this matter. We suggest that this topic should be re-evaluated using higher-quality study methods, particularly national joint registries studies and randomised controlled trials.
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Affiliation(s)
- Yushy Zhou
- Department of Orthopaedic Surgery, St. Vincent's Hospital, Melbourne, Victoria, Australia.
| | - Siddharth Rele
- Department of Orthopaedic Surgery, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Osama Elsewaisy
- Department of Orthopaedic Surgery, St. Vincent's Hospital, Melbourne, Victoria, Australia
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Jürgens-Lahnstein JH, Petersen ET, Rytter S, Madsen F, Søballe K, Stilling M. Stable polyethylene inlay fixation and low polyethylene wear rate in fixed-bearing total knee arthroplasty at five to six years' follow-up. Bone Joint Res 2024; 13:226-236. [PMID: 38719208 PMCID: PMC11090217 DOI: 10.1302/2046-3758.135.bjr-2023-0126.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
Aims Micromotion of the polyethylene (PE) inlay may contribute to backside PE wear in addition to articulate wear of total knee arthroplasty (TKA). Using radiostereometric analysis (RSA) with tantalum beads in the PE inlay, we evaluated PE micromotion and its relationship to PE wear. Methods A total of 23 patients with a mean age of 83 years (77 to 91), were available from a RSA study on cemented TKA with Maxim tibial components (Zimmer Biomet). PE inlay migration, PE wear, tibial component migration, and the anatomical knee axis were evaluated on weightbearing stereoradiographs. PE inlay wear was measured as the deepest penetration of the femoral component into the PE inlay. Results At mean six years' follow-up, the PE wear rate was 0.08 mm/year (95% confidence interval 0.06 to 0.09 mm/year). PE inlay external rotation was below the precision limit and did not influence PE wear. Varus knee alignment did not influence PE wear (p = 0.874), but increased tibial component total translation (p = 0.041). Conclusion The PE inlay was well fixed and there was no relationship between PE stability and PE wear. The PE wear rate was low and similar in the medial and lateral compartments. Varus knee alignment did not influence PE wear.
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Affiliation(s)
- Jonathan H. Jürgens-Lahnstein
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Emil T. Petersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
- University Clinic for Hand, Hip and Knee Surgery, Holstebro Regional Hospital, Aarhus, Denmark
| | - Søren Rytter
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Frank Madsen
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Kjeld Søballe
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
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Tarassoli P, Corban LE, Wood JA, Sergis A, Chen DB, MacDessi SJ. Long leg radiographs underestimate the degree of constitutional varus limb alignment and joint line obliquity in comparison with computed tomography: a radiographic study. Knee Surg Sports Traumatol Arthrosc 2023; 31:4755-4765. [PMID: 37490128 DOI: 10.1007/s00167-023-07505-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/05/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE The purpose of this study was to understand if differences exist between computed tomography (CT) and long leg radiographs (LLR) when defining coronal plane alignment of the lower limb in total knee arthroplasty (TKA). It aimed to identify any such differences between the two imaging modalities by quantifying constitutional limb alignment (arithmetic hip-knee-ankle angle (aHKA), joint line obliquity (JLO) and Coronal Plane Alignment of the Knee (CPAK) type within the same population. METHODS A retrospective radiographic study compared pre-operative LLR and CT measurements in patients undergoing robotic-assisted TKA. The aHKA, JLO and CPAK types were calculated after measuring the medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA). The primary outcomes were the mean differences in aHKA (MPTA-LDFA), JLO (MPTA + LDFA) and proportions of CPAK types between LLR and CT groups. The secondary outcomes were the differences in CT-derived MPTA values based on four different tibial sagittal landmarks. RESULTS After exclusions, 465 imaging sets were analysed in 394 patients. There was a statistically significant mean difference between LLR and CT, respectively, for both MPTA (87.5° vs. 86.2°; p < 0.01) and LDFA (88.7° vs. 87.3°; p < 0.01). There were also statistically significant differences for aHKA (- 0.2° vs. - 1.1°) and JLO (175.1° vs. 173.4°) for LLR and CT, respectively (both p < 0.01). CT increased the proportion of patients with CPAK Type I (constitutional varus aHKA, apex distal JLO) and CPAK Type II (neutral aHKA, apex distal JLO), and decreased numbers of CPAK Types III-VI. There were significant mean differences in the MPTA using varying sagittal landmarks. CONCLUSION Alignment determined by LLRs underestimates the magnitude of both constitutional varus alignment and joint line obliquity compared to CT, differences that notably increase the proportions of patients included in CPAK Types I and II. These distinctions are primarily due to underestimation of proximal tibial varus when measured on LLRs compared to CT, which more specifically defines articular weight-bearing points. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Payam Tarassoli
- Sydney Knee Specialists, Suite 201, Level 2, 131 Princes Hwy, Kogarah, NSW, 2217, Australia
| | - Luke E Corban
- Sydney Knee Specialists, Suite 201, Level 2, 131 Princes Hwy, Kogarah, NSW, 2217, Australia
| | - Jil A Wood
- Sydney Knee Specialists, Suite 201, Level 2, 131 Princes Hwy, Kogarah, NSW, 2217, Australia
| | - Andrew Sergis
- Stryker Australia, 8 Herbert St, St Leonards, NSW, 2065, Australia
| | - Darren B Chen
- Sydney Knee Specialists, Suite 201, Level 2, 131 Princes Hwy, Kogarah, NSW, 2217, Australia
- St George Private Hospital, 1 South St, Kogarah, NSW, 2217, Australia
| | - Samuel J MacDessi
- Sydney Knee Specialists, Suite 201, Level 2, 131 Princes Hwy, Kogarah, NSW, 2217, Australia.
- St George Private Hospital, 1 South St, Kogarah, NSW, 2217, Australia.
- School of Clinical Medicine, University of New South Wales, St George and Sutherland Campuses, Sydney, NSW, Australia.
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Ebramzadeh E. Don't Throw the Baby Out with the Bathwater: Commentary on an article by Barbara H. Currier, MChE, et al.: "Oxidation in Retrieved, Never-Irradiated UHMWPE Bearings. What Can We Learn About in Vivo Oxidation?". J Bone Joint Surg Am 2023; 105:e14. [PMID: 36790394 DOI: 10.2106/jbjs.22.01261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- Edward Ebramzadeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, California
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Giustra F, Bistolfi A, Bosco F, Fresia N, Sabatini L, Berchialla P, Sciannameo V, Massè A. Highly cross-linked polyethylene versus conventional polyethylene in primary total knee arthroplasty: comparable clinical and radiological results at a 10-year follow-up. Knee Surg Sports Traumatol Arthrosc 2023; 31:1082-1088. [PMID: 36409325 PMCID: PMC9958150 DOI: 10.1007/s00167-022-07226-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/06/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Highly crosslinked polyethylene (HXLPE) was introduced in total knee arthroplasty (TKA) to reduce wear and consequent revisions for loosening due to conventional polyethylene (CPE) wear. This study aims to analyse whether HXLPE is as safe as CPE and could improve the TKA clinical and radiological results in a long-term follow-up. METHODS This retrospective study included all consecutive starting series of 223 patients with severe primary knee osteoarthritis (OA), with a minimum follow-up of 10 years treated between July 1st, 2007, and July 31st, 2010. After excluding patients who did not respect the inclusion and exclusion criteria, 128 patients were included in the analysis of this study. The patients were then divided into two groups according to the type of polyethylene (PE) implanted: CPE or HXLPE liners. All patients were evaluated for clinical and radiological parameters, causes and revision rates related to the type of PE implanted. RESULTS HXLPE appears to be as safe as CPE in TKA, reporting no higher revisions for osteolysis, prosthesis loosening, infection, and mechanical failure. Nevertheless, no statistically significant differences were found between the two groups in the clinical and radiological outcomes evaluated. CONCLUSIONS Clinical, radiological results, and revision rates are similar between HXLPE and CPE in TKA after 10 years of follow-up, although HXLPE benefits remain controversial. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Fortunato Giustra
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126 Turin, Italy
| | - Alessandro Bistolfi
- Orthopaedics and Traumatology, Ospedale Cardinal Massaia Asti, Via Conte Verde 125, 14100 Asti, Italy
| | - Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy.
| | - Nicolò Fresia
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126 Turin, Italy
| | - Luigi Sabatini
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126 Turin, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Veronica Sciannameo
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126 Turin, Italy
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CORR Insights®: No Reduction in Revision Risk Associated With Highly Cross-linked Polyethylene With or Without Antioxidants Over Conventional Polyethylene in TKA: An Analysis From the American Joint Replacement Registry. Clin Orthop Relat Res 2022; 480:1937-1939. [PMID: 36006667 PMCID: PMC9473755 DOI: 10.1097/corr.0000000000002387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/09/2022] [Indexed: 01/31/2023]
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LEWIS PL, W-DAHL A, ROBERTSSON O, PRENTICE HA, GRAVES SE. Impact of patient and prosthesis characteristics on common reasons for total knee replacement revision: a registry study of 36,626 revision cases from Australia, Sweden, and USA. Acta Orthop 2022; 93:623-633. [PMID: 35819795 PMCID: PMC9275496 DOI: 10.2340/17453674.2022.3512] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Total knee replacement (TKR) studies usually analyze all-cause revision when considering relationships with patient and prosthesis factors. We studied how these factors impact different revision diagnoses. PATIENTS AND METHODS We used data from 2003 to 2019 of TKR for osteoarthritis from the arthroplasty registries of Sweden, Australia, and Kaiser Permanente, USA to study patient and prosthesis characteristics for specific revision diagnoses. There were 1,072,924 primary TKR included and 36,626 were revised. Factors studied included age, sex, prosthesis constraint, fixation method, bearing mobility, polyethylene type, and patellar component use. Revision diagnoses were arthrofibrosis, fracture, infection, instability, loosening, pain, patellar reasons, and wear. Odds ratios (ORs) for revision were estimated and summary effects were calculated using a meta-analytic approach. RESULTS We found between-registry consistency in 15 factor/reason analyses. Risk factors for revision for arthrofibrosis were age < 65 years (OR 2.0; 95% CI 1.4-2.7) and mobile bearing designs (MB) (OR 1.7; CI 1.1-2.5), for fracture were female sex (OR 3.2; CI 2.2-4.8), age ≥ 65 years (OR 2.8; CI 1.9-4) and posterior stabilized prostheses (PS) (OR 2.1; CI 1.3-3.5), for infection were male sex (OR 1.9; CI 1.7-2.0) and PS (OR 1.5; CI 1.2-1.8), for instability were age < 65 years (OR 1.5; CI 1.3-1.8) and MB (OR 1.5; CI 1.1-2.2), for loosening were PS (OR 1.5; CI 1.4-1.6), MB (OR 2.2; CI 1.6-3.0) and use of ultra-high molecular weight polyethylene (OR 2.3; CI 1.8-2.9), for patellar reasons were not resurfacing the patella (OR 13.6; CI 2.1-87.2) and MB (OR 2.0; CI 1.2-3.3) and for wear was cementless fixation (OR 4.9; CI 4.3-5.5). INTERPRETATION Patients could be counselled regarding specific age and sex risks. Use of minimally stabilized, fixed bearing, cemented prostheses, and patellar components is encouraged to minimize revision risk.
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Affiliation(s)
- Peter L LEWIS
- Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia,Department of Orthopedics, Clinical Science Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Annette W-DAHL
- Swedish Knee Arthroplasty Register, Lund, Sweden,Department of Orthopedics, Clinical Science Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Otto ROBERTSSON
- Swedish Knee Arthroplasty Register, Lund, Sweden,Department of Orthopedics, Clinical Science Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | | | - Stephen E GRAVES
- Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia
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LEWIS PL, W-DAHL A, ROBERTSSON O, LORIMER M, PRENTICE HA, GRAVES SE, PAXTON EW. The effect of patient and prosthesis factors on revision rates after total knee replacement using a multi-registry meta-analytic approach. Acta Orthop 2022; 93:284-293. [PMID: 35113168 PMCID: PMC8808477 DOI: 10.2340/17453674.2022.1997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Characteristics of patients receiving total knee arthroplasty (TKA) and prostheses used vary between regions and change with time. How these practice variations influence revision remains unclear. We combined registry data for better understanding of the impact of variation, which could potentially improve revision rates. PATIENTS AND METHODS We used data from 2003 to 2019 for primary TKA from arthroplasty registries of Sweden (SKAR), Australia (AOANJRR), and Kaiser Permanente (KPJRR). We included 1,072,924 TKA procedures for osteoarthritis. Factors studied included age, sex, ASA class, BMI category, prosthesis constraint, fixation, bearing mobility, patellar resurfacing, and polyethylene type. Cumulative percentage revision (CPR) was calculated using Kaplan-Meier estimates, and unadjusted Cox hazard ratios were used for comparisons. Random-effects generic inverse-variance meta-analytic methods were used to determine summary effects. RESULTS We found similarities in age and sex, but between-registry differences occurred in the other 7 factors studied. Patients from Sweden had lower BMI and ASA scores compared with other registries. Use of cement fixation was similar in the SKAR and KPJRR, but there were marked differences in patellar resurfacing and posterior stabilized component use. Meta-analysis results regarding survivorship favored patients aged ≥ 65 years and minimally stabilized components. There were inconsistent results with time for sex, fixation, and bearing mobility, and no differences for the patellar resurfacing or polyethylene type comparisons. INTERPRETATION Marked practice variation was found. Use of minimally stabilized and possibly also cemented and fixed bearing prostheses is supported.
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Affiliation(s)
- Peter L LEWIS
- Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, SA Australia,Lund University, Faculty of Medicine, Clinical Science Lund, Department of Orthopedics, Lund, Sweden
| | - Annette W-DAHL
- Swedish Knee Arthroplasty Register, Lund, Sweden,Lund University, Faculty of Medicine, Clinical Science Lund, Department of Orthopedics, Lund, Sweden
| | - Otto ROBERTSSON
- Swedish Knee Arthroplasty Register, Lund, Sweden,Lund University, Faculty of Medicine, Clinical Science Lund, Department of Orthopedics, Lund, Sweden
| | - Michelle LORIMER
- Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, SA Australia
| | | | - Stephen E GRAVES
- Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, SA Australia
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Mell SP, Wimmer MA, Jacobs JJ, Lundberg HJ. Optimal surgical component alignment minimizes TKR wear - An in silico study with nine alignment parameters. J Mech Behav Biomed Mater 2022; 125:104939. [PMID: 34740015 PMCID: PMC8710043 DOI: 10.1016/j.jmbbm.2021.104939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 01/03/2023]
Abstract
Currently, preclinical mechanical wear testing of total knee replacements (TKRs) is done using ideally aligned components using standardized TKR level walking under either force or displacement-control regimes. To understand the influence of implant alignment and testing control regime, we studied the effect of nine component alignment parameters on TKR volumetric wear in silico. We used a computational framework combining Latin Hypercube sampling design of experiments, finite element analysis, and a numerical model of polyethylene wear, to create a predictive model of how component alignment affects wear rate for each control regime. Nine component alignment parameters were investigated, five femoral variables and four tibial variables. To investigate perturbations of the nine implant alignment variables, two separate 300-point designs were executed, one for each control regime. The results were then used to generate surrogate statistical models using stepwise multiple linear regression. Wear at the neutral position was 4.5mm3/million cycle and 8.6mm3/million cycle for displacement and force-control, respectively. Stepwise multiple linear regression surrogate models were highly significant for each control regime, but force-control generated a stronger predictive model, with a higher R2, more included terms, and a lower RMSE. Both models predicted transverse plane rotational mismatch can lead to large changes in predicted wear; a transverse plane alignment mismatch of 15° can elicit a change in wear of up to 5mm3/million cycle, almost double that of neutral alignment. Therefore, transverse plane alignment is particularly important when considering failure of the implant due to wear.
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Bistolfi A, Giustra F, Bosco F, Faccenda C, Viotto M, Sabatini L, Berchialla P, Sciannameo V, Graziano E, Massè A. Comparable results between crosslinked polyethylene and conventional ultra-high molecular weight polyethylene implanted in total knee arthroplasty: systematic review and meta-analysis of randomised clinical trials. Knee Surg Sports Traumatol Arthrosc 2022; 30:3120-3130. [PMID: 35182171 PMCID: PMC9418273 DOI: 10.1007/s00167-022-06879-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 01/12/2022] [Indexed: 12/17/2022]
Abstract
PURPOSE Total knee arthroplasty (TKA) has experienced exponential growth over the last decade, including increasingly younger patients with high functional demands. Highly crosslinked polyethylene (HXLPE) has been proven effective in reducing osteolysis and loosening revisions while improving long-term survival and performance in total hip arthroplasty; nevertheless, this superiority is not demonstrated in TKA. The aim of this systematic review and meta-analysis was to examine whether HXLPE improved overall survival and postoperative functional and radiological outcomes compared to conventional polyethylene (CPE) in TKA. METHODS According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, a literature search of five databases (PubMed, Medline, Scopus, Science Direct and Embase) was made. A PICOS model was performed. The initial screening identified 2541 studies. Each eligible clinical article was analysed according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence (LoE). Only randomised clinical trials (RCTs) of LoE 1 and 2 were included. The methodological quality of the articles was assessed using the Risk of Bias 2 (RoB 2) tool. RESULTS Six clinical studies were included in the final study. This systematic review and meta-analysis were registered on the International Prospective Register of Systematic Reviews (PROSPERO). A total of 2285 knees were included. Eight outcomes (total reoperations, reoperations for prosthesis loosening and infections, radiolucent lines, osteolysis, mechanical failure, postoperative KSS knee score and function score) were analysed. For none of them, a statistically significant difference was found about the superiority of HXLPE over CPE (p > 0.05). CONCLUSIONS There were no statistically significant differences between HXLPE and CPE for TKA concerning clinical, radiological, and functional outcomes; nevertheless, HXLPE did not show higher failure rates or complications and can be safely used for TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Alessandro Bistolfi
- Orthopaedics and Traumatology, Ospedale Cardinal Massaia Asti, via Conte Verde 125, 14100 Asti, Italy
| | | | | | | | | | - Luigi Sabatini
- grid.432329.d0000 0004 1789 4477AO Città della Salute e della Scienza, Turin, Italy
| | - Paola Berchialla
- grid.7605.40000 0001 2336 6580Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - Veronica Sciannameo
- grid.7605.40000 0001 2336 6580Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - Eugenio Graziano
- Orthopaedics and Traumatology, Ospedale Cardinal Massaia Asti, via Conte Verde 125, 14100 Asti, Italy
| | - Alessandro Massè
- University of the Studies of Turin, Turin, Italy ,grid.432329.d0000 0004 1789 4477AO Città della Salute e della Scienza, Turin, Italy
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