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Bonanzinga T, Gambaro FM, Iacono F, Leogrande F, Di Lascio L, Marcacci M. All-Polyethylene Versus Metal-Backed Tibial Components in Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials. J Arthroplasty 2024; 39:1353-1360. [PMID: 37931827 DOI: 10.1016/j.arth.2023.10.058] [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: 06/06/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND In the literature, there is no evidence suggesting the superiority in clinical performance between all-polyethylene (AP) and metal-backed (MB) tibial implants in total knee arthroplasty. The aim of this study was to systematically review the literature to collect only high-quality studies investigating the differences in terms of clinical and radiostereometric analysis (RSA) outcomes of AP compared to MB implants. METHODS Only randomized controlled trials (RCTs) reporting either clinical or RSA outcomes have been included. Data sources were Embase, Medline, and the Cochrane Central Register of Controlled Trials. RESULTS We included eleven RCTs evaluating the outcomes of 1,377 patients. Of the RCTs, 9 of them showed a low risk and 2 showed moderate risk of bias. There was no statistically significant difference in terms of clinical outcomes and survival rate between the AP and MB group; however, a statistically significant lower mean lift-off in the AP group (0.19 mm) compared to the MB group (0.3 mm) was observed on RSA. CONCLUSIONS The performance of AP total knee arthroplasty in terms of clinical outcomes and 5-year survival was not statistically different when compared to the MB group. However, the RSA showed a statistically significant lower mean lift-off in the AP group.
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Affiliation(s)
- Tommaso Bonanzinga
- IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy; Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesco Manlio Gambaro
- IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy; Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesco Iacono
- IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy; Humanitas University, Pieve Emanuele, Milan, Italy
| | - Federica Leogrande
- IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy; Humanitas University, Pieve Emanuele, Milan, Italy
| | - Luciana Di Lascio
- IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy; Humanitas University, Pieve Emanuele, Milan, Italy
| | - Maurilio Marcacci
- IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy; Humanitas University, Pieve Emanuele, Milan, Italy
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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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Pain and patellofemoral functionality in total knee arthroplasty: a comparative cohort study of two prosthesis designs. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim YH, Park JW, Kim JS. Clinical Results of Fixed-Bearing and Rotating-Platform Total Knee Prostheses. Orthopedics 2018; 41:88-94. [PMID: 29494742 DOI: 10.3928/01477447-20180226-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/10/2018] [Indexed: 02/03/2023]
Abstract
Inconsistent results have been reported for posterior-stabilized fixed-bearing and rotating-platform total knee prostheses. The authors sought to determine whether the design changes of these prostheses had led to their achieving their intended objectives at minimum 10-year follow-up. Furthermore, the authors sought to delineate the specific features of these knee prostheses to which good outcomes are attributed. One hundred patients (mean age, 66.2 years) were included in this study. Mean follow-up was 10.4 years (range, 10-11 years). The patients were assessed clinically and radiographically with the Knee Society clinical rating system. In addition, the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire was used and the University of California at Los Angeles activity scores were determined preoperatively and at each follow-up visit. The mean Knee Society knee score was 90 points (range, 70-100 points) in the fixed-bearing group and 92 points (range, 75-100 points) in the rotating-platform group at final follow-up. Mean Western Ontario and McMaster Universities Osteoarthritis Index score was 16 points (range, 5-46 points) in the fixed-bearing group and 16 points (range, 6-49 points) in the rotating-platform group. Mean University of California at Los Angeles activity score was 6.5 points (range, 4-10 points) at final follow-up in both groups. No knee had aseptic loosening of the components, and neither group had osteolysis. The predicted implant survival at 10.4 years was 99% as the endpoint of any reoperation in both groups. The findings of this study suggest that cemented posterior-stabilized fixed-bearing and rotating-platform prostheses have favorable clinical and radiographic results. [Orthopedics. 2018; 41(2):88-94.].
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Ishii Y, Noguchi H, Sato J, Sakurai T, Toyabe SI. Comparison of long-term clinical outcomes after bilateral mobile-bearing total knee arthroplasties using PCL-retaining and PCL-substituting implants in the same patients. Knee Surg Sports Traumatol Arthrosc 2017; 25:3711-3717. [PMID: 27139227 DOI: 10.1007/s00167-016-4155-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Whether the posterior cruciate ligament (PCL) should be retained or substituted in total knee arthroplasty (TKA) remains an issue of concern. The purpose of this study was to perform within-patient comparisons of mid- and long-term clinical outcomes after mobile-bearing TKA using PCL-retaining (PCLR) and PCL-substituting (PCLS) implant designs. METHODS Clinical outcomes were assessed in thirty-eight patients (76 knees) who underwent bilateral scheduled staged TKA with a PCLR design on one side and a PCLS design on the other. Median follow-up periods were 118 months (range 60-211) and 114 months (62-198) in knees with PCLR and PCLS implants, respectively. The preoperative diagnosis for all patients was osteoarthritis. The postoperative clinical results of mobile-bearing TKAs using PCLR and PCLS implant designs were evaluated. RESULTS The postoperative Hospital for Special Surgery and the new Knee Society Knee Scoring System scores revealed no differences between PCLR and PCLS implant designs. Postoperative flexion and extension also did not differ between designs. Postoperative median femorotibial alignment was 4° for PCLR and 5° for PCLS implants, respectively; this difference was not significant. Six of the knees with PCLR and three of the knees with PCLS implants had radiolucent lines around the tibial prostheses; these were less than 1 mm and nonprogressive. CONCLUSIONS Clinically good results were obtained at approximately 10 years after mobile-bearing TKA using both PCLR and PCLS implant designs bilaterally in the same patients. These results provide conclusive evidence that equivalent clinical results can be obtained with either implant design. LEVEL OF EVIDENCE Therapeutic study, Level II.
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Affiliation(s)
- Yoshinori Ishii
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan.
| | - Hideo Noguchi
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Junko Sato
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Tetsuya Sakurai
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Shin-Ichi Toyabe
- Division of Information Science and Biostatistics, Niigata University Graduate School of Medical and Dental Sciences, 1 Asahimachi Dori Niigata, Niigata, 951-8520, Japan
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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: 21] [Impact Index Per Article: 3.0] [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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Zhang W, Liu J, Shi H, Yang K, Wang P, Wang G, Liu N, Wang H, Ji J, Chu PK. Communication between nitric oxide synthase and positively-charged surface and bone formation promotion. Colloids Surf B Biointerfaces 2016; 148:354-362. [PMID: 27619187 DOI: 10.1016/j.colsurfb.2016.08.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/30/2016] [Accepted: 08/27/2016] [Indexed: 12/11/2022]
Abstract
Despite the effects on physiology of bone marrow mesenchymal stem cells (BMSCs) and bone tissue, biological signal communication between bone implants and them is seldom employed as a guidance to create an osteo-inductive interface. Herein, the positively-charged surface is constructed on bone implant from the perspective of mediation of nitric oxide synthase (NOS) expression to signal BMSCs osteo-differentiation. In vitro and in vivo results indicate that the proper surface potential on the positively-charged surface affects NOS to express a high level of inducible nitric oxide synthase (iNOS) in three NOS isoforms of the contacted BMSCs, upregulates their osteogenetic expression, and ultimately foster new bone growth. However, an excessively high surface potential produces substantial immunomodulatory effects thereby offsetting the aforementioned advantages. This study demonstrates that fine-tuning of the positively-charged surface and proper utilization of the communication between NOS and bone implants promote bone formation.
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Affiliation(s)
- Wei Zhang
- Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China.
| | - Jun Liu
- Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Haigang Shi
- Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Kun Yang
- Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Pingli Wang
- Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Gexia Wang
- Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Na Liu
- Stomatology Department of the General Hospital of Chinese PLA, 28 FuXing Road, Beijing 100853, China
| | - Huaiyu Wang
- Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, Guangdong, China
| | - Junhui Ji
- Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China.
| | - Paul K Chu
- Department of Physics & Materials Science, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, China
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Zhang W, Liu J, Shi H, Liu N, Yang K, Shi L, Gu B, Wang H, Ji J, Chu PK. Effects of plasma-generated nitrogen functionalities on the upregulation of osteogenesis of bone marrow-derived mesenchymal stem cells. J Mater Chem B 2015; 3:1856-1863. [DOI: 10.1039/c4tb02071e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A tertiary amine constructed controllably by plasma technology possesses the optimal capability to promote BMSC osteogenesis.
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Affiliation(s)
- Wei Zhang
- Technical Institute of Physics and Chemistry
- Chinese Academy of Sciences
- Beijing 100190
- China
| | - Jun Liu
- Technical Institute of Physics and Chemistry
- Chinese Academy of Sciences
- Beijing 100190
- China
| | - Haigang Shi
- Technical Institute of Physics and Chemistry
- Chinese Academy of Sciences
- Beijing 100190
- China
| | - Na Liu
- Stomatology Department of the General Hospital of Chinese PLA
- Beijing 100853
- China
| | - Kun Yang
- Technical Institute of Physics and Chemistry
- Chinese Academy of Sciences
- Beijing 100190
- China
| | - Lianxin Shi
- Technical Institute of Physics and Chemistry
- Chinese Academy of Sciences
- Beijing 100190
- China
| | - Bin Gu
- Stomatology Department of the General Hospital of Chinese PLA
- Beijing 100853
- China
| | - Huaiyu Wang
- Department of Physics & Materials Science
- City University of Hong Kong
- Hong Kong
- China
| | - Junhui Ji
- Technical Institute of Physics and Chemistry
- Chinese Academy of Sciences
- Beijing 100190
- China
| | - Paul K. Chu
- Department of Physics & Materials Science
- City University of Hong Kong
- Hong Kong
- China
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Gilbert SL, Rana AJ, Lipman JD, Wright TM, Westrich GH. Design changes improve contact patterns and articular surface damage in total knee arthroplasty. Knee 2014; 21:1129-34. [PMID: 25127488 DOI: 10.1016/j.knee.2014.07.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 06/09/2014] [Accepted: 07/21/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Optetrak PS (Exactech, Inc., Gainesville, FL) has been a well-functioning posterior stabilized knee replacement since its introduction in 1995. In 2009, the Optetrak Logic incorporated modifications to the anterior face of the tibial post and the corresponding anterior articulating surface of the femoral component to reduce edge loading on the polyethylene post. In this study, we provide the rationale for the design change and compare the damage on retrieved tibial components of both designs to demonstrate the effectiveness of the design modifications in decreasing post damage. METHODS We integrated retrieval findings of tibial post damage with finite element analysis to redesign the anterior tibial post-femoral box articulation. We then used subsequent retrieval analysis on a 3:1 matched sample of 60 PS and 20 Logic inserts to examine the impact of the design change on polyethylene damage. RESULTS Polyethylene stresses were markedly reduced when rounded contact geometries were incorporated. The comparison of the new and old designs using retrieval analysis demonstrated that the redesign led to reduction in surface damage and deformation on the tibial post. CONCLUSIONS This study shows the use of a design cycle by which a problem is identified through retrieval analysis, analytical tools are used to suggest design solutions, and then retrieval analysis is applied again on the new design to confirm improved performance. CLINICAL RELEVANCE Anterior post damage has been markedly reduced through the introduction of design changes to the post-box geometry.
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Affiliation(s)
| | - Adam J Rana
- Hospital for Special Surgery, New York, NY, United States
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The effect of viscosity on cement penetration in total knee arthroplasty, an application of the squeeze film effect. J Arthroplasty 2014; 29:2039-42. [PMID: 25007724 DOI: 10.1016/j.arth.2014.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 05/14/2014] [Accepted: 05/19/2014] [Indexed: 02/01/2023] Open
Abstract
The authors present a prospective randomized blinded cadaver study designed to evaluate the engineering concept of a squeeze film effect and the effect of cement viscosity on cement penetration in total knee arthroplasty. This was done in response to an earlier clinical study demonstrating inferior tibial cement penetration using early, often liquid, phase cement. Paired cadaver tibias were implanted with the tibial component using either liquid or dough phase cement. Based on an AP fluoroscopic image, the dough phase cement penetrated deeper than liquid in all four zones. This was statistically significant in zones 1, 2 and 3. Deeper cement penetration has been shown to provide a stronger cement-bone interphase. As a result dough phase cement is recommended to obtain optimal cement penetration.
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Gudnason A, Hailer NP, W-Dahl A, Sundberg M, Robertsson O. All-Polyethylene Versus Metal-Backed Tibial Components-An Analysis of 27,733 Cruciate-Retaining Total Knee Replacements from the Swedish Knee Arthroplasty Register. J Bone Joint Surg Am 2014; 96:994-999. [PMID: 24951734 DOI: 10.2106/jbjs.m.00373] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Currently, the use of metal-backed tibial components is more common than the use of all-polyethylene components in total knee arthroplasty. However, the available literature indicates that all-polyethylene tibial components are not inferior to the metal-backed design. We hypothesized that there would be no difference in the ten-year survival rate between all-polyethylene and metal-backed tibial components of a specific design in a large nationwide cohort. METHODS In the Swedish Knee Arthroplasty Register, we identified 27,733 cruciate-retaining total knee replacements using the press-fit condylar prosthesis with either metal-backed or all-polyethylene tibial components inserted from 1999 to 2011. Unadjusted survival functions were calculated with the end points of revision for any reason, revision due to infection, and revision due to reasons other than infection, and the differences between the groups were investigated with the log-rank test. Cox proportional hazard models were fitted to analyze the influence of various covariates on the adjusted relative risk of revision. RESULTS The median duration of follow-up was 4.5 years (range, zero to 12.9 years). Of all total knee replacements, 16,896 (60.9%) were in women and 10,837 (39.1%) were in men. Metal-backed components were used in 16,011 total knee arthroplasties (57.7%) and all-polyethylene in 11,722 total knee arthroplasties (42.3%). With revision for any reason as the end point, the all-polyethylene tibial component had slightly superior, unadjusted ten-year survival compared with the metal-backed component: 97.2% (95% confidence interval [CI], 96.7% to 97.7%) compared with 96.6% (95% CI, 96.2% to 96.9%; p = 0.002). Cox multiple regression analysis adjusting for age group, sex, and patellar resurfacing showed that all-polyethylene components had a reduced risk of revision for any reason (relative risk = 0.75; 95% CI, 0.64 to 0.89) and a reduced risk of revision due to infection (relative risk = 0.63; 95% CI, 0.46 to 0.86). Patellar resurfacing and male sex increased the risk of revision due to infection (relative risk = 2.22 [95% CI, 1.37 to 3.62] and 2.21 [95% CI, 1.66 to 2.94], respectively). CONCLUSIONS These all-polyethylene tibial components were at least as good as or superior to metal-backed tibial components with respect to implant survivorship at ten years in cruciate-retaining total knee replacements. We concluded that these less expensive all-polyethylene tibial components can be safely and effectively used in total knee arthroplasty. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Asgeir Gudnason
- Department of Orthopedics, Institute of Surgical Sciences, Uppsala University Hospital, SE-751 85, Uppsala, Sweden. E-mail address:
| | - Nils P Hailer
- Department of Orthopedics, Institute of Surgical Sciences, Uppsala University Hospital, SE-751 85, Uppsala, Sweden. E-mail address:
| | - Annette W-Dahl
- The Swedish Knee Arthroplasty Register, Department of Orthopedics and Clinical Sciences, Lund University, SE-221 85, Lund, Sweden
| | - Martin Sundberg
- The Swedish Knee Arthroplasty Register, Department of Orthopedics and Clinical Sciences, Lund University, SE-221 85, Lund, Sweden
| | - Otto Robertsson
- The Swedish Knee Arthroplasty Register, Department of Orthopedics and Clinical Sciences, Lund University, SE-221 85, Lund, Sweden
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Pai SK, Whitwell G, McMurray D, Stewart TD, Stone MH. Long-term results of a total knee prosthesis utilising an all polyethylene tibial component. Arch Orthop Trauma Surg 2013; 133:1143-8. [PMID: 23748907 DOI: 10.1007/s00402-013-1786-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The aim of this study was to assess the long-term performance of a cemented total knee replacement utilising an All Polyethylene Tibial (APT) component and in addition to perform an engineering analysis of any failures to help refine surgical technique. MATERIALS AND METHODS A total of 26 patients had a total knee replacement performed using a cemented Depuy Press Fit Condylar (PFC) APT component and a cruciate retaining femoral component. At final review all patients were assessed using The Knee Society Score together with radiographs. An engineering analysis simulated loading conditions of the implants that failed and these were compared with the performance of a modular metal-backed Tibial (MBT) component. RESULTS A total of 20 patients were reviewed at mean time of 116 months following surgery. Knee Society Knee Scores and Function Scores in this cohort were 84/100 and 58/100, respectively. Two patients required revision for tibial component failure. Pre-operatively both had valgus deformities and in each case the tibial tray had been lateralised leaving a gap on the medial side where the APT component had no rigid support. The engineering analysis demonstrated that the volume of highly strained cancellous bone was greater in the APT design compared with the MBT design when a model with a 3 mm medial gap was loaded. The stiffer MBT base plate acted more rigidly and shielded the stress applied to the proximal tibial cancellous bone. CONCLUSION The APT component demonstrated satisfactory clinical and radiographic performance at long-term follow up. Appropriate cortical support of the APT component is important. The implant should be used with a degree of caution in patients with severe deformities and osteoporosis.
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Affiliation(s)
- Sunil K Pai
- Department of Orthopaedic Surgery, Chapel Allerton Hospital, Harehills Lane, Leeds, LS7 4SA, UK.
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Nouta KA, Verra WC, Pijls BG, Schoones JW, Nelissen RGHH. All-polyethylene tibial components are equal to metal-backed components: systematic review and meta-regression. Clin Orthop Relat Res 2012; 470:3549-59. [PMID: 22972656 PMCID: PMC3492632 DOI: 10.1007/s11999-012-2582-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 08/22/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Less than 1% of all primary TKAs are performed with an all-polyethylene tibial component, although recent studies indicate all-polyethylene tibial components are equal to or better than metal-backed ones. QUESTIONS/PURPOSES We asked whether the metal-backed tibial component was clinically superior to the all-polyethylene tibial component in primary TKAs regarding revision rates and clinical functioning, and which modifying variables affected the revision rate. METHODS We systematically reviewed the literature for clinical studies comparing all-polyethylene and metal-backed tibial components used in primary TKAs in terms of revision rates, clinical scores, and radiologic parameters including radiostereometric analysis (RSA). Meta-regression techniques were used to explore factors modifying the observed effect. Our search yielded 1557 unique references of which 26 articles were included, comprising more than 12,500 TKAs with 231 revisions for any reason. RESULTS Meta-analysis showed no differences between the all-polyethylene and metal-backed components except for higher migration of the metal-backed components. Meta-regression showed strong evidence that the all-polyethylene design has improved with time compared with the metal-backed design. CONCLUSIONS The all-polyethylene components were equivalent to metal-backed components regarding revision rates and clinical scores. The all-polyethylene components had better fixation (RSA) than the metal-backed components. The belief that metal-backed components are better than all-polyethylene ones seems to be based on studies from earlier TKAs. This might no longer be true for modern TKAs. LEVEL OF EVIDENCE Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Klaas Auke Nouta
- Department of Orthopaedics, Leiden University Medical Center, Postal Code J11R, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Wiebe C. Verra
- Department of Orthopaedics, Leiden University Medical Center, Postal Code J11R, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Bart G. Pijls
- Department of Orthopaedics, Leiden University Medical Center, Postal Code J11R, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Jan W. Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob G. H. H. Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Postal Code J11R, PO Box 9600, 2300 RC Leiden, The Netherlands
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Petty W, Miller G, Burstein A. Commentary on an article by C.-E. Thelu et al.: "poor results of the Optetrak(TM) cemented posterior stabilized knee prosthesis after a mean 25-month follow-up: analysis of 110 prostheses". Orthop Traumatol Surg Res 2012; 98:706-8. [PMID: 23036317 DOI: 10.1016/j.otsr.2012.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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15
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Bae DK, Song SJ, Park MJ, Eoh JH, Song JH, Park CH. Twenty-year survival analysis in total knee arthroplasty by a single surgeon. J Arthroplasty 2012; 27:1297-1304.e1. [PMID: 22177792 DOI: 10.1016/j.arth.2011.10.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Accepted: 10/24/2011] [Indexed: 02/01/2023] Open
Abstract
Between January 1988 and December 2006, a total of 3014 primary total knee arthroplasties (TKAs) in 2042 patients were performed, and survivorship analysis was performed. Survivorship analysis showed a 10-year survival of 93.8% and a 20-year survival of 70.9%. There was no significant difference in the survival rate according to sex and diagnosis (P = .142 and .443, respectively). The survival rate was higher in the patients older than 60 years (P < .001). The survival rate of Total Condylar IV (TC-IV) was higher than that of Ortholoc (Dow Corning Wright Medical, Arlington, Tenn) (P < .001). Total knee arthroplasty results in satisfactory long-term survival rates. However, the survival rate decreases over time. The risk of requiring revision TKA was related to age and type of implants. Careful consideration is necessary to decide the time for TKA and select type of implants.
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Affiliation(s)
- Dae Kyung Bae
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
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Cheng T, Pan X, Liu T, Zhang X. Tibial component designs in primary total knee arthroplasty: should we reconsider all-polyethylene component? Knee Surg Sports Traumatol Arthrosc 2012; 20:1438-49. [PMID: 21971938 DOI: 10.1007/s00167-011-1682-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Accepted: 09/13/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE Despite the frequency with which total knee arthroplasties (TKAs) are performed, whether they are best performed using all-polyethylene or metal-backed tibial components remains a controversy. The aim of the present study was to determine the advantages and disadvantages of metal-backed compared with all-polyethylene tibial components during TKAs through an evaluation of current literature. METHODS A meta-analysis and systematic review of randomized and non-randomized comparative studies comparing metal-backed with all-polyethylene tibial components during TKAs were performed. The focus of the analysis was on the outcomes of knee score, range of motion (ROM), quality of life, implant alignment, tibial migration, radiolucent line, complication, reoperation, and implant survivorship. RESULTS A total of 10 randomized/quasi-randomized controlled trials and 13 non-randomized comparative studies assessing 19,767 TKAs were eligible. On the basis of these studies, no significant differences were found between the 2 groups with regard to knee score, ROM, quality of life, complication, and reoperation. The findings indicated that using all-polyethylene tibial components is associated with lower continuous migration rate compared with metal-backed tibial components. Only 13 studies provided adequate data on implant survivorship during intermediate or long-term follow-up. Of these, 9 found that no statistical significance existed between the 2 groups. The other 3 studies found that using all-polyethylene components yielded a higher survival rate than using metal-backed components. CONCLUSIONS Metal-backed tibial components had no obvious advantages over all-polyethylene tibial components in TKAs. However, this finding should be interpreted with caution due to publication bias, low methodological quality of the included studies, and different surgical interventions. LEVEL OF EVIDENCE Therapeutic study (systematic review and meta-analysis), Level III.
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Affiliation(s)
- Tao Cheng
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yisan Road, Shanghai, 200233, People's Republic of China
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Thelu CE, Pasquier G, Maynou C, Migaud H. Poor results of the Optetrak™ cemented posterior stabilized knee prosthesis after a mean 25-month follow-up: analysis of 110 prostheses. Orthop Traumatol Surg Res 2012; 98:413-20. [PMID: 22613936 DOI: 10.1016/j.otsr.2012.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 02/20/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The introduction of a new knee arthroplasty model, even if it differs from a validated implant by only a few details, should be followed by rigorous assessment. The Optetrak™ cemented posterior stabilized knee prosthesis evolved from the Insall prosthesis with a smaller tibial keel associated with a higher tibial cam and increased femorotibial congruency as well as a more posterior-stabilized trochlea. HYPOTHESIS We hypothesized that this implant with only minor modifications to the Insall prosthesis would provide as favorable results as the Insall prosthesis. MATERIALS AND METHODS A continuous series of 110 prostheses (106 patients) implanted between 2005 and 2007 was retrospectively analyzed with a mean follow-up of 25 months (range, 12-42 months) by an independent observer. The follow-up was based on the IKS score and the radiological assessment was conducted by three senior surgeons. RESULTS The mean IKS score was 83.7 (range, 13-100) points at the last follow-up, the mean function score was 82.6 (range, 30-100 points), and mean flexion was 120° (range, 80-140°). Seventeen patients (15%) were disappointed or dissatisfied, 25 knees (22%) were painful, requiring regular painkillers. The prostheses had a satisfactory mechanical axis, with a mean HKA angle of 177.4 ± 4°, but 25 prostheses (22%) presented rims evolving toward tibial implant loosening, and 24 (21%) developed signs of patellofemoral conflict. With follow-up less than 5 years, nine cases were revised for tibial loosening, three for patellofemoral instability, and one for patellofemoral pain. The cases of tibial loosening were particular because they occurred at the cement-tibial-implant interface. The cumulated survival rate at 36 months was 80.97 ± 9.1% and 76.74 ± 12% at 45 months. DISCUSSION This tibial implant with a small keel does not resist the stresses applied by posterior stabilization, with notably a higher level of stress than the Insall prosthesis from which it was derived. In cases of centering defect, the design of the trochlea can lead to impingement between the edges of the patella and the prominent edges of the prosthetic trochlea. We have suspended implantation of this prosthesis and continue to monitor the progression of patients having received these implants. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- C-E Thelu
- Faculté de médecine, Lille Nord-de-France University, 59045 Lille cedex, France
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