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Diaz Dilernia F, Blanchard T, Vasarhelyi E, Lanting B, Howard J. Minimum 2 Year Outcomes of All-Polyethylene Tibial Components in Patients who have Body Mass Index of 35 or Greater. J Arthroplasty 2023; 38:S157-S163. [PMID: 37019318 DOI: 10.1016/j.arth.2023.03.078] [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: 11/14/2022] [Revised: 03/26/2023] [Accepted: 03/26/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Several studies have reported negative results after total knee arthroplasty (TKA) in obese patients. This study aims to analyze the minimum 2 year outcomes in patients who have a body mass index (BMI) ˃35 undergoing cemented TKA using an all-polyethylene tibial component (APTC) at a minimum of two years of follow-up. METHODS We retrospectively studied 163 obese patients (192 TKAs) who underwent a primary cemented TKA using an APTC comparing the outcomes of 96 TKA patients who had a BMI ˃35 to 39.9 (group A) with 96 patients who a TKA and a BMI ≥ 40 (group B). Median follow-up of groups A and B was 3.8 years and 3.5 years respectively (P=0.02). Multiple regression analyses were performed to evaluate independent risk factors associated with complications. Kaplan-Meier survival curves were estimated, defining failure as the need for any further femoral or tibial revision surgery with implant removal, irrespective of the reason. RESULTS There was no significant difference at the latest follow-up patient reported outcomes between both groups. Survivorship, as defined by revision for any reason, was 99% for group A and 99% for group B (P=1.00). There was one aseptic tibial failure in group A, and one septic failure in group B. Multiple regression analyses showed no significant associations between age (Odds Ratio [OR]= 1.00; P=0.98; 95% Confidence Interval (CI)= 0.93 to 1.08), sex (OR=1.38; P=0.70; 95% CI=0.26 to 7.25), BMI (OR=1.00; P=0.95; 95% CI=0.87 to 1.16), and complication rate. CONCLUSIONS At a median 3.7-year follow-up, the use of an APTC provided excellent outcomes and survivorship in patients who had Class 2 and Class 3 obesity.
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Affiliation(s)
- Fernando Diaz Dilernia
- Division of Orthopedic Surgery, London Health Sciences Centre, Western University, University Hospital, 339 Windermere Road, London, Ontario, Canada, N6A 5A5
| | - Trevor Blanchard
- Division of Orthopedic Surgery, London Health Sciences Centre, Western University, University Hospital, 339 Windermere Road, London, Ontario, Canada, N6A 5A5
| | - Edward Vasarhelyi
- Division of Orthopedic Surgery, London Health Sciences Centre, Western University, University Hospital, 339 Windermere Road, London, Ontario, Canada, N6A 5A5
| | - Brent Lanting
- Division of Orthopedic Surgery, London Health Sciences Centre, Western University, University Hospital, 339 Windermere Road, London, Ontario, Canada, N6A 5A5
| | - James Howard
- Division of Orthopedic Surgery, London Health Sciences Centre, Western University, University Hospital, 339 Windermere Road, London, Ontario, Canada, N6A 5A5.
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The Medium-Term Survival Analysis of an All-Polyethylene Tibia in a Single-Series Cohort of Over 1000 Knees. J Arthroplasty 2020; 35:2837-2842. [PMID: 32498968 DOI: 10.1016/j.arth.2020.05.017] [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: 02/24/2020] [Revised: 05/01/2020] [Accepted: 05/07/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total knee arthroplasty is a successful elective orthopedic procedure with an increasing number being undertaken. Original knee arthroplasties used an all-polyethylene tibia; however, with concerns over tibial loosening, the trend moved toward the metal-backed variety. Modern designs providing more conformity and changes in manufacturing of the polyethylene make it an equivalent but cheaper option. METHODS We analyzed the medium-term outcome in 1092 patients with an all-polyethylene tibial component in their total knee arthroplasty. RESULTS Twenty-six patients had further surgery on their knee for a variety of reasons. Assessing reoperation for any reason, the 7-year survival rate was 96.96% with an overall infection rate of 0.37%. Seven-year survival analysis using aseptic loosening as a criteria was 99.28%. Both the Short Form 12 physical score and Western Ontario and McMaster Universities Osteoarthritis Index score significantly improved and was sustained at 7 years. Body mass did not correlate to either outcomes or complications. CONCLUSION An all-polyethylene tibia in a total knee arthroplasty has good outcome data and high patient satisfaction with good survivorship in the medium term, coupled with potential cost-saving benefits.
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Makhdom AM, Parvizi J. Modular versus nonmodular tibial inserts in total knee arthroplasty: what are the differences? ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:225. [PMID: 28603740 DOI: 10.21037/atm.2017.02.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Asim M Makhdom
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Javad Parvizi
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Houdek MT, Watts CD, Wyles CC, Martin JR, Trousdale RT, Taunton MJ. Metal or Modularity: Why Do Metal-Backed Tibias Have Inferior Outcomes to All-Polyethylene Tibial Components in Patients With Osteoarthritis. J Arthroplasty 2017; 32:836-842. [PMID: 27816367 DOI: 10.1016/j.arth.2016.09.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/01/2016] [Accepted: 09/24/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Biomechanical studies have suggested improved stress distribution in metal-backed (MB) compared to all-polyethylene (AP) tibias, but such potential benefits have not been realized clinically. The purpose of this investigation was to analyze the outcomes of AP components in patients with primary osteoarthritis and compare the results to those obtained with MB tibial components in total knee arthroplasty (TKA). METHODS We reviewed 11,653 patients undergoing primary TKA for osteoarthritis. There were 9999 (86%) MB (8470 modular and 1529 monoblock) and 1654 (14%) AP tibial components. All patients had at least 2 years of clinical follow-up with mean follow-up of 8 years (range, 2-30 years). RESULTS Mean survivorship for all primary TKAs at the 5-year, 10-year, 15-year, and 20-year time points was 97%, 92%, 86%, and 78%. AP tibial components were found to have improved survivorship when compared to modular and monoblock MB counterparts (P < .0001). Likewise, AP tibial components were found to have lower rates of tibial component loosening (P < .0001), tibial osteolysis, and component fracture. Furthermore, the AP group had improved survival rates in most age-groups except <55 years where there was no difference. AP tibial components demonstrated improved survival for all body mass index (BMI) groups except in patients with a BMI ≤25 kg/m2 where there was no difference. CONCLUSION AP tibial components had significantly improved implant survival across all age-groups and most BMI categories in patients who underwent TKA for osteoarthritis. Given these outcomes, AP tibias are a reasonable option, regardless of patient age and BMI.
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Affiliation(s)
- Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Chad D Watts
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - John R Martin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Nguyen LCL, Lehil MS, Bozic KJ. Trends in total knee arthroplasty implant utilization. J Arthroplasty 2015; 30:739-42. [PMID: 25613663 DOI: 10.1016/j.arth.2014.12.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/01/2014] [Accepted: 12/04/2014] [Indexed: 02/01/2023] Open
Abstract
The incidence of total knee arthroplasty (TKA) has increased alongside our knowledge of knee physiology, kinematics, and technology resulting in an evolution of TKA implants. This study examines the trends in TKA implant utilization. Data was extracted from The Orthopedic Research Network to evaluate trends in level of constraint, fixed vs. mobile bearing, fixation, and type of polyethylene in primary TKAs. In 2012, 88% used cemented femoral and tibial implants, and 96% involved patellar resurfacing. 38% of implants were cruciate retaining, 53% posterior stabilized or condylar stabilized, 3% constrained. 91% were fixed-bearing, 7% mobile-bearing. 52% of tibial inserts were HXLPE. TKA implant trends demonstrate a preference for cemented femoral and tibial components, patellar resurfacing, fixed-bearing constructs, metal-backed tibial components, patellar resurfacing, and increased usage of HXLPE liners.
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Affiliation(s)
- Long-Co L Nguyen
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Mandeep S Lehil
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Kevin J Bozic
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California; Philip. R Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
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Kremers HM, Sierra RJ, Schleck CD, Berry DJ, Cabanela ME, Hanssen AD, Pagnano MW, Trousdale RT, Lewallen DG. Comparative Survivorship of Different Tibial Designs in Primary Total Knee Arthroplasty. J Bone Joint Surg Am 2014; 96:e121. [PMID: 25031383 DOI: 10.2106/jbjs.m.00820] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few registry-based studies in the United States have compared the survivorship of different knee implant designs in total knee arthroplasty. The purpose of this study was to compare differences in survivorship of commonly used tibial implant designs in primary total knee arthroplasty. METHODS A total of 16,584 primary total knee arthroplasties in 11,992 patients were performed at a single institution from 1985 to 2005. Patients were prospectively followed at regular intervals to ascertain details of subsequent revisions. Overall revision rates and revisions for aseptic loosening, wear, and osteolysis were compared across twenty-two tibial implant designs using Cox proportional hazards regression models adjusting for age, sex, calendar year, and body mass index. RESULTS In comparison with metal-backed modular implants, all-polyethylene tibial components had a significantly lower risk of revision (hazard ratio, 0.3; 95% confidence intervals: 0.2, 0.5 [p < 0.0001]). The risk reduction with all-polyethylene tibial components was not affected by age, sex, or body mass index. With metal-backed modular tibial designs, cruciate-retaining knees performed better than the posterior-stabilized knees (p = 0.002), but this finding was limited to one specific metal-backed modular tibial component, the Press Fit Condylar design. With all-polyethylene tibial components, there was no survivorship difference between cruciate-retaining and posterior-stabilized designs. CONCLUSIONS All-polyethylene tibial components were associated with better outcomes than metal-backed modular components. Cruciate-retaining and posterior-stabilized designs performed equally well, except with the Press Fit Condylar design. Obese patients may have superior results with all-polyethylene and posterior-stabilized components. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hilal Maradit Kremers
- Departments of Health Sciences Research (H.M.K. and C.D.S.) and Orthopedic Surgery (R.J.S., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address for H.M. Kremers:
| | - Rafael J Sierra
- Departments of Health Sciences Research (H.M.K. and C.D.S.) and Orthopedic Surgery (R.J.S., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address for H.M. Kremers:
| | - Cathy D Schleck
- Departments of Health Sciences Research (H.M.K. and C.D.S.) and Orthopedic Surgery (R.J.S., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address for H.M. Kremers:
| | - Daniel J Berry
- Departments of Health Sciences Research (H.M.K. and C.D.S.) and Orthopedic Surgery (R.J.S., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address for H.M. Kremers:
| | - Miguel E Cabanela
- Departments of Health Sciences Research (H.M.K. and C.D.S.) and Orthopedic Surgery (R.J.S., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address for H.M. Kremers:
| | - Arlen D Hanssen
- Departments of Health Sciences Research (H.M.K. and C.D.S.) and Orthopedic Surgery (R.J.S., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address for H.M. Kremers:
| | - Mark W Pagnano
- Departments of Health Sciences Research (H.M.K. and C.D.S.) and Orthopedic Surgery (R.J.S., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address for H.M. Kremers:
| | - Robert T Trousdale
- Departments of Health Sciences Research (H.M.K. and C.D.S.) and Orthopedic Surgery (R.J.S., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address for H.M. Kremers:
| | - David G Lewallen
- Departments of Health Sciences Research (H.M.K. and C.D.S.) and Orthopedic Surgery (R.J.S., D.J.B., M.E.C., A.D.H., M.W.P., R.T.T., and D.G.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail address for H.M. Kremers:
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Bal BS, Rahaman MN. Orthopedic applications of silicon nitride ceramics. Acta Biomater 2012; 8:2889-98. [PMID: 22542731 DOI: 10.1016/j.actbio.2012.04.031] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 04/18/2012] [Accepted: 04/19/2012] [Indexed: 11/29/2022]
Abstract
Silicon nitride (Si(3)N(4)) is a ceramic material developed for industrial applications that demand high strength and fracture resistance under extreme operating conditions. Recently, Si(3)N(4) has been used as an orthopedic biomaterial, to promote bone fusion in spinal surgery and to develop bearings that can improve the wear and longevity of prosthetic hip and knee joints. Si(3)N(4) has been implanted in human patients for over 3 years now, and clinical trials with Si(3)N(4) femoral heads in prosthetic hip replacement are contemplated. This review will provide background information and data relating to Si(3)N(4) ceramics that will be of interest to engineering and medical professionals.
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Affiliation(s)
- B S Bal
- Department of Orthopaedic Surgery, School of Medicine, University of Missouri, Columbia, MO 65211, USA.
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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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Abstract
BACKGROUND AND PURPOSE The choice of either all-polyethylene (AP) tibial components or metal-backed (MB) tibial components in total knee arthroplasty (TKA) remains controversial. We therefore performed a meta-analysis and systematic review of randomized controlled trials that have evaluated MB and AP tibial components in primary TKA. METHODS The search strategy included a computerized literature search (Medline, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials) and a manual search of major orthopedic journals. A meta-analysis and systematic review of randomized or quasi-randomized trials that compared the performance of tibial components in primary TKA was performed using a fixed or random effects model. We assessed the methodological quality of studies using Detsky quality scale. RESULTS 9 randomized controlled trials (RCTs) published between 2000 and 2009 met the inclusion quality standards for the systematic review. The mean standardized Detsky score was 14 (SD 3). We found that the frequency of radiolucent lines in the MB group was significantly higher than that in the AP group. There were no statistically significant differences between the MB and AP tibial components regarding component positioning, knee score, knee range of motion, quality of life, and postoperative complications. INTERPRETATION Based on evidence obtained from this study, the AP tibial component was comparable with or better than the MB tibial component in TKA. However, high-quality RCTs are required to validate the results.
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Affiliation(s)
- Tao Cheng
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | | | - Xianlong Zhang
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
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