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Kagan R, Andrawis J, Kendall J, De A, Mullen K, Sassoon AA. Lower Associated Risk of Revision With All-Polyethylene Tibial Components in Total Knee Arthroplasty: An Analysis of the American Joint Replacement Registry. J Arthroplasty 2024:S0883-5403(24)00681-8. [PMID: 38944062 DOI: 10.1016/j.arth.2024.06.060] [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: 01/30/2024] [Revised: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Despite the potential advantage of all-polyethylene tibial components, modular metal-backed component use predominates the market in the United States for total knee arthroplasty (TKA). This is partially driven by concerns about the associated revision risk due to the lack of modularity with all-polyethylene components. This study utilized the American Joint Replacement Registry to compare the associated risk of all-cause revision and revision for infection for all-polyethylene versus modular metal-backed tibial components. METHODS An analysis of primary TKA cases in patients aged 65 years and older was performed with American Joint Replacement Registry data linked to Centers for Medicare and Medicaid Services data from 2012 to 2019. Analyses compared all-polyethylene to modular metal-backed tibial components. We identified 485,024 primary TKA cases, consisting of 479,465 (98.9%) metal-backed and 5,559 (1.1%) all-polyethylene. Cox proportional hazard regression analyses created hazard ratios (HRs) to evaluate the association of design and the risk of all-cause revision while adjusting for sex, age, and the competing risk of mortality. Event-free survival curves evaluate time to revision. RESULTS The all-polyethylene tibia group demonstrated a decreased risk for all-cause revision (HR = 0.37; 95% confidence interval: 0.24 to 0.55; P < .0001) and revision for infection (HR = 0.41; 95% confidence interval: 0.22 to 0.77, P < .0001). Event-free survival curves demonstrated a decreased risk of all-cause revision that persisted across time points until 8 years post-TKA. CONCLUSIONS In the United States, all-polyethylene tibial component use for TKA remains low compared to modular metal-backed designs. A decreased associated risk for revision should ease concerns about the use of all-polyethylene components in patients aged 65 years or older, and future investigations should investigate the potential cost and value savings associated with expanded use in this population. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Ryland Kagan
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - John Andrawis
- Department of Orthopaedics, Harbor - University of California Medical Center, Torrance, California
| | - Jamil Kendall
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Ayushmita De
- American Academy of Orthopaedic Surgeons, Registries and Data Science Department, Rosemont, Illinois
| | - Kyle Mullen
- American Academy of Orthopaedic Surgeons, Registries and Data Science Department, Rosemont, Illinois
| | - Adam A Sassoon
- Department of Orthopaedic Surgery, University of California Los Angeles Medical Center, Santa Monica, California
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Apostolopoulos V, Boháč P, Marcián P, Nachtnebl L, Mahdal M, Pazourek L, Tomáš T. Biomechanical comparison of all-polyethylene total knee replacement and its metal-backed equivalent on periprosthetic tibia using the finite element method. J Orthop Surg Res 2024; 19:153. [PMID: 38396020 PMCID: PMC10893603 DOI: 10.1186/s13018-024-04631-0] [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: 11/22/2023] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) with all-polyethylene tibial (APT) components has shown comparable survivorship and clinical outcomes to that with metal-backed tibial (MBT). Although MBT is more frequently implanted, APT equivalents are considered a low-cost variant for elderly patients. A biomechanical analysis was assumed to be suitable to compare the response of the periprosthetic tibia after implantation of TKA NexGen APT and MBT equivalent. METHODS A standardised load model was used representing the highest load achieved during level walking. The geometry and material models were created using computed tomography data. In the analysis, a material model was created that represents a patient with osteopenia. RESULTS The equivalent strain distribution in the models of cancellous bone with an APT component showed values above 1000 με in the area below the medial tibial section, with MBT component were primarily localised in the stem tip area. For APT variants, the microstrain values in more than 80% of the volume were in the range from 300 to 1500 με, MBT only in less than 64% of the volume. CONCLUSION The effect of APT implantation on the periprosthetic tibia was shown as equal or even superior to that of MBT despite maximum strain values occurring in different locations. On the basis of the strain distribution, the state of the bone tissue was analysed to determine whether bone tissue remodelling or remodelling would occur. Following clinical validation, outcomes could eventually modify the implant selection criteria and lead to more frequent implantation of APT components.
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Affiliation(s)
- Vasileios Apostolopoulos
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Boháč
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, University of Technology, Brno, Czech Republic
| | - Petr Marcián
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, University of Technology, Brno, Czech Republic
| | - Luboš Nachtnebl
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michal Mahdal
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lukáš Pazourek
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomáš Tomáš
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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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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Apostolopoulos V, Nachtnebl L, Mahdal M, Pazourek L, Boháč P, Janíček P, Tomáš T. Clinical outcomes and survival comparison between NexGen all-poly and its metal-backed equivalent in total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2023; 47:2207-2213. [PMID: 37069277 PMCID: PMC10439055 DOI: 10.1007/s00264-023-05772-3] [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: 11/06/2022] [Accepted: 03/10/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE This study aims to compare total knee replacement (TKA) with NexGen All-Poly (APT) and NexGen Metal-Backed (MBT) in terms of implant survivorship, reasons leading to implant failure and functional results of defined age categories. METHODS A single-centre, retrospective evaluation of 812 patients who underwent knee replacement with NexGen CR between 2005 and 2021, comparing a modern congruent APT component to a modular MBT equivalent component using a similar surgical technique at a notable mean follow-up duration. Implant survival, functional outcomes using the Knee Society Score and range of motion were evaluated and compared in different age categories. RESULTS Of the 812 NexGen CR TKAs performed at our institution, 410 (50.4%) used APT components and 402 (49.6%) MBT components. The survival rate of NexGen APT was 97.1% and that of NexGen MBT was 93.2% (p = 0.36). Removal of the implant occurred overall in 15 cases, for MBT in ten cases, and for APT in four cases. The FS was proved to be significantly higher when APT components were implanted in younger patients than for MBT (p = 0.005). A similar range of motion between the components was recorded (p = 0.1926). CONCLUSION Under defined conditions, we measured the clinical results of implants from a single manufacturer implanted in a single department using a similar surgical technique. Considering the limitations, we suggest that all-polyethylene tibial components are equal or even superior to metal-backed ones across the examined age categories.
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Affiliation(s)
- Vasileios Apostolopoulos
- First Department of Orthopaedic Surgery, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, FN u Sv Anny Brne, Pekarska 53, Brno, 60200 Czechia
| | - Luboš Nachtnebl
- First Department of Orthopaedic Surgery, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, FN u Sv Anny Brne, Pekarska 53, Brno, 60200 Czechia
| | - Michal Mahdal
- First Department of Orthopaedic Surgery, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, FN u Sv Anny Brne, Pekarska 53, Brno, 60200 Czechia
| | - Lukáš Pazourek
- First Department of Orthopaedic Surgery, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, FN u Sv Anny Brne, Pekarska 53, Brno, 60200 Czechia
| | - Petr Boháč
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, University of Technology, Brno, Czechia
| | - Pavel Janíček
- First Department of Orthopaedic Surgery, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, FN u Sv Anny Brne, Pekarska 53, Brno, 60200 Czechia
| | - Tomáš Tomáš
- First Department of Orthopaedic Surgery, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, FN u Sv Anny Brne, Pekarska 53, Brno, 60200 Czechia
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Jabbal M, Clement N, Walmsley PJ. All-polyethylene tibia components have the same functional outcomes and survival, and are more cost-effective than metal-backed components in patients 70 years and older undergoing total knee arthroplasty : propensity match study with a minimum five-year follow-up. Bone Jt Open 2022; 3:969-976. [PMID: 36519385 PMCID: PMC9783277 DOI: 10.1302/2633-1462.312.bjo-2022-0063.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIMS The tibial component of total knee arthroplasty can either be an all-polyethylene (AP) implant or a metal-backed (MB) implant. This study aims to compare the five-year functional outcomes of AP tibial components to MB components in patients aged over 70 years. Secondary aims are to compare quality of life, implant survivorship, and cost-effectiveness. METHODS A group of 130 patients who had received an AP tibial component were matched for demographic factors of age, BMI, American Society of Anesthesiologists (ASA) grade, sex, and preoperative Knee Society Score (KSS) to create a comparison group of 130 patients who received a MB tibial component. Functional outcome was assessed prospectively by KSS, quality of life by 12-Item Short-Form Health Survey questionnaire (SF-12), and range of motion (ROM), and implant survivorships were compared. The SF six-dimension (6D) was used to calculate the incremental cost effectiveness ratio (ICER) for AP compared to MB tibial components using quality-adjusted life year methodology. RESULTS The AP group had a mean KSS-Knee of 83.4 (standard deviation (SD) 19.2) and the MB group a mean of 84.9 (SD 18.2; p = 0.631), while mean KSS-Function was 75.4 (SD 15.3) and 73.2 (SD 16.2 p = 0.472), respectively. The mental (44.3 vs 45.1; p = 0.464) and physical (44.8 vs 44.9; p = 0.893) dimensions of the SF-12 and ROM (97.9° vs 99.7°; p = 0.444) were not different between the groups. Implant survivorship at five years were 99.2% and 97.7% (p = 0.321). The AP group had a greater SF-6D gain of 0.145 compared to the MB group, with an associated cost saving of £406, which resulted in a negative ICER of -£406/0.145 = -£2,800. Therefore, the AP tibial component was dominant, being a more effective and less expensive intervention. CONCLUSION There were no differences in functional outcomes or survivorship at five years between AP and MB tibial components in patients aged 70 years and older, however the AP component was shown to be more cost-effective. In the UK, only 1.4% of all total knee arthroplasties use an AP component; even a modest increase in usage nationally could lead to significant financial savings.Cite this article: Bone Jt Open 2022;3(12):969-976.
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Affiliation(s)
- Monu Jabbal
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK,Department of Orthopaedic Surgery, Victoria Hospital, Kirkcaldy, UK
| | - Nick Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Phil J. Walmsley
- Department of Orthopaedic Surgery, Victoria Hospital, Kirkcaldy, UK,School of Medicine, University of St Andrews, St Andrews, UK,Correspondence should be sent to Phil J. Walmsley. E-mail:
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Kendall J, Pelt CE, Yep P, Mullen K, Kagan R. Trends in Polyethylene Design and Manufacturing Characteristics for Total Knee Arthroplasty: An Analysis From the American Joint Replacement Registry. J Arthroplasty 2022; 37:659-667. [PMID: 34826567 DOI: 10.1016/j.arth.2021.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/29/2021] [Accepted: 11/04/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Advances in polyethylene bearing characteristics have led to various options for total knee arthroplasty. We examine trends in use of polyethylene in the United States. METHODS An analysis of American Joint Replacement Registry data from 2012 to 2019 for primary total knee arthroplasty procedures was conducted. Design and manufacturing characteristics were obtained and validated in the American Joint Replacement Registry dataset. Polyethylene bearing design and manufacturing use characteristics were compared by year, gender, age group, and geographic region of the procedure. Descriptive analysis was performed. RESULTS We identified 993,292 cases over the study period. In total, 791,233 (80%) cases had complete device data available and were included in analysis. In addition, 366,280 (49.4%) cases utilized minimally stabilized bearings compared to 374,809 (50.6%) for posterior-stabilized bearings. Posterior-stabilized use was stable over the study period and highest in the Northeast (64.5%; P < .0001). Cruciate-retaining use decreased from 29.7% to 20.2% and anterior-stabilized use increased from 17.4% to 25.2%. Conventional polyethylene use decreased from 42.8% to 21.9%, and was highest in the 81+ age group (37.8%; P < .0001) and Northeast (43.0%; P < .0001). Highly cross-linked polyethylene (HXLPE) with antioxidant use increased from 9.08% to 31.8%, while HXLPE without antioxidant use remained constant. CONCLUSION There was an increase in use of anterior-stabilized and pivot bearings and an increase in use of HXLPE with antioxidant. Additionally, there were noted age group and regional differences in the use of various bearings. Further study should evaluate if these changing utilization trends are related to clinical outcomes, or due to regional training, preferences, or manufacturer pressures. LEVEL OF EVIDENCE Level III, retrospective.
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Affiliation(s)
- Jamil Kendall
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR
| | - Christopher E Pelt
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT
| | - Patrick Yep
- American Academy of Orthopaedic Surgeons, Combined Analytics Team, Registries and Quality, Rosemont, IL
| | - Kyle Mullen
- American Academy of Orthopaedic Surgeons, Combined Analytics Team, Registries and Quality, Rosemont, IL
| | - Ryland Kagan
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR
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Total Knee Arthroplasty in Octogenarians: Should We Still Be so Restrictive? Geriatrics (Basel) 2021; 6:geriatrics6030067. [PMID: 34209013 PMCID: PMC8293102 DOI: 10.3390/geriatrics6030067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/23/2021] [Accepted: 06/26/2021] [Indexed: 11/17/2022] Open
Abstract
Demand for total knee arthroplasty (TKA) in octogenarians will increase in subsequent years as society ages. We conducted a retrospective observational study in octogenarians operated on with TKA between 2015 and 2019, comparing preoperative and postoperative Knee Society Score (KSS), Knee Society Function Score (KSFS), extension and flexion balance, and radiologic alignment using a paired Student t-test. A chi-squared test was used to correlate mortality with Charlson comorbidities index score and with ASA scale. Kaplan-Meier analysis was performed to calculate patient survival. In this period 36 patients ≥80 years underwent TKA, with a mean age of 81.6 years. Of these, 24 patients (66.7%) were classified as ASA II and 12 (33.3%) as ASA III. Sixteen patients (44.4%) were Charlson 0, 14 (38.9%) Charlson 1, two (5.6%) Charlson 2, and four (11.1%) Charlson 3. KSS, KSFS, flexion and extension range, and radiologic alignment were statistically significant (p < 0.001) when comparing preoperatory and post-operatory data. No correlation (p > 0.05) was found between mortality and ASA or Charlson score. Seven patients (19.4%) suffered a medical complication and two patients experienced surgical complications. Four patient died (11.1%) during follow-up. The mean patient survival was 67.4 months. Patients ≥80 years achieve clinical improvement after TKA. Comorbidities, not age, are the burden for surgery in older patients.
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Cost-Effectiveness of Arthroplasty Management in Hip and Knee Osteoarthritis: a Quality Review of the Literature. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bernthal NM, Burke ZDC, Hegde V, Upfill-Brown A, Chen CJ, Hwang R, Eckardt JJ. Long-term follow-up of all-polyethylene tibial components when used for oncological endoprosthetic reconstruction. Bone Joint J 2020; 102-B:170-176. [PMID: 32009432 DOI: 10.1302/0301-620x.102b2.bjj-2019-0535.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS We aimed to examine the long-term mechanical survivorship, describe the modes of all-cause failure, and identify risk factors for mechanical failure of all-polyethylene tibial components in endoprosthetic reconstruction. METHODS This is a retrospective database review of consecutive endoprosthetic reconstructions performed for oncological indications between 1980 and 2019. Patients with all-polyethylene tibial components were isolated and analyzed for revision for mechanical failure. Outcomes included survival of the all-polyethylene tibial component, revision surgery categorized according to the Henderson Failure Mode Classification, and complications and functional outcome, as assessed by the Musculoskeletal Tumor Society (MSTS) score at the final follow-up. RESULTS A total of 278 patients were identified with 289 all-polyethylene tibial components. Mechanical survival was 98.4%, 91.1%, and 85.2% at five, ten and 15 years, respectively. A total of 15 mechanical failures were identified at the final follow-up. Of the 13 all-polyethylene tibial components used for revision of a previous tibial component, five (38.5%) failed mechanically. Younger patients (< 18 years vs > 18 years; p = 0.005) and those used as revision components (p < 0.001) had significantly increased rates of failure. Multivariate logistic regression modelling showed revision status to be a positive risk factor for failure (odds ratio (OR) 19.498, 95% confidence interval (CI) 4.598 to 82.676) and increasing age was a negative risk factor for failure (OR 0.927, 95% CI 0.872 to 0.987). Age-stratified risk analysis showed that age > 24 years was no longer a statistically significant risk factor for failure. The final mean MSTS score for all patients was 89% (8.5% to 100.0%). CONCLUSION The long-term mechanical survivorship of all-polyethylene tibial components when used for tumour endoprostheses was excellent. Tumour surgeons should consider using these components for their durability and the secondary benefits of reduced cost and ease of removal and revision. However, caution should be taken when using all-polyethylene tibial components in the revision setting as a significantly higher rate of mechanical failure was seen in this group of patients. Cite this article: Bone Joint J. 2020;102-B(2):170-176.
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Affiliation(s)
- Nicholas M Bernthal
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, University of California, Santa Monica, California, USA
| | - Zachary D C Burke
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, University of California, Santa Monica, California, USA
| | - Vishal Hegde
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, University of California, Santa Monica, California, USA
| | - Alexander Upfill-Brown
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, University of California, Santa Monica, California, USA
| | - Clark J Chen
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, University of California, Santa Monica, California, USA
| | - Richard Hwang
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, University of California, Santa Monica, California, USA
| | - Jeffrey J Eckardt
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, University of California, Santa Monica, California, USA
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10
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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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Cemented all-poly tibia in resource constrained country, affordable and cost-effective care. Is it applicable at this era? Review article. Ann Med Surg (Lond) 2019; 47:36-40. [PMID: 31641501 PMCID: PMC6796550 DOI: 10.1016/j.amsu.2019.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/23/2019] [Indexed: 12/26/2022] Open
Abstract
Osteoarthritis of knee is a progressive disease requiring total knee replacement in advanced stage. TKR is being performed in high numbers in developing countries as well. It carries significant economic burden on health system including high cost of implants. Initially, tibial components were cemented all polyethylene monoblock constructs. Subsequent studies showed excellent long term follow up in terms of durability up to 20 years.Successive studies reported aseptic loosening as the cause of failure but such studies failed to address factors responsible for failure other than implant. Cemented metal-backed non-modular tibial components (MBT) are implants in current use. They provide modularity in terms of polyethylene thickness, stems wedges. A literature reported cost saving of $1.17 million, by operating 16,500 total joints using all poly-tibial tibial component rather than metal backed tibial component. studies have reported no significant difference in terms of survivorship, function and backside wear. Methods For this study only English written articles were included. Studies included case reports, case series, RCTs and systemic reviews related to all polyethylene tibial components. Articles reporting all levels of evidence – Level I to IV- were included as part of our research. PubMed, Google Scholar and Cochrane Reviews databases from 2000 to 2016 were searched for studies. Results Information was gathered and thoroughly studied from 30 articles with overall result in favor of the APTC implant. Conclusion All polyethylene tibial component (APTC) is an appealing and cost effective alternative, and is associated with the excellent survivorship and lower risk of revision. In light of the present-day economic evidence and long-term functional outcome, all-polyethylene should be in more use than metal backed especially in resource-constrained setting. Total Knee Arthroplasty revolutionized the management of end-stage arthritis of the knee. Tibial components were cemented all polyethylene monoblock with decreased bone resection. Cemented metal-backed non-modular tibial components (MBT) were subsequently introduced. Incremental cost can be a devastating problem for the patients at resource-constrained settings. In this era of competitive implant's industries, cost-effective options should be explored and adapted.
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