All-Polyethylene Compared with Metal-Backed Tibial Components in Total Knee Arthroplasty at Ten Years

Bettinson, K.; Pinder, I. M.; Moran, Chris; Weir, David J.; Lingard, Elizabeth A.

doi:10.2106/jbjs.g.01427

Cited by 61 publications

(46 citation statements)

References 19 publications

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“…The results of our series of 851 TKAs were consistent with recent literature confirming excellent survivorship of APT implants in a broad cross section of TKA patients [1,3,5,14,18,22,25,26,29,32,34]. The operative surgeon had previous experience with APT components, illustrated by the clinical results of the APT1 group in this study and a previous study [26].…”

Section: Discussionsupporting

confidence: 90%

“…Two studies from the same institution [31,34] reported only one failure and good overall results after 2 to 11 years' followup of 242 APT components in younger, more active TKA patients. The results of this study include younger patients, and the 98.9% survivorship is similar to previous studies of APT components demonstrating survivorships of greater than 97% at more than 10 years of followup in older patients [3,5,14,22,25,28,29,34]. The results of the APT1 group, with no revisions noted at an average 152 months of followup, validate the enduring performance of APT components in an age-and activity-selected patient population.…”

Section: Discussionsupporting

confidence: 84%

“…Consequently, APT components became less frequently utilized, most often being implanted in older or lower-demand patients [1,22,26]. In the late 1990s, the survivorship of APT components in low-demand patients was greater than 95% at 10 or more years of followup, and utilization in non-age-or activityselected patients began [3,5,14,25,29,32,34]. Surgeons implanted APT components fabricated with polyethylene sterilized with gamma irradiation and sealed in a vacuum, designed with a stiff tibial keel, and manufactured in a variety of sizes to cover the proximal tibial cortical surface in patients throughout the demand spectrum.…”

Section: Introductionmentioning

confidence: 99%

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All-polyethylene and Metal-backed Tibial Components Are Equivalent With BMI of Less Than 37.5

Toman¹,

Iorio²,

Healy³

2012

Clinical Orthopaedics &Amp; Related Research

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Background Modular, metal-backed tibial (MBT) components are associated with locking mechanism dysfunction, breakage, backside wear, and osteolysis, which compromise survivorship. All-polyethylene tibial (APT) components eliminate problems associated with MBTs, but, historically, APT utilization has generally been limited to older, less active patients. However, it is unclear whether APT utilization can be expanded to a nonselected patient population. Questions/purposes We therefore determined the survivorship of APT components compared with MBT components in a non-age-or activity-selected population who underwent TKA. Methods Using a longitudinal database, we identified 775 patients with primary TKAs utilizing a single implant design between 1999 and 2007. Of these, 558 (72%) patients had APT components (APT2), while 217 (28%) patients with tibial bone loss or defects, contralateral MBT components, or a BMI of greater than 37.5 received MBT components. We determined the survivorship in the two groups. The minimum followup was 2 years for both groups (mean ± SD: MBT, 80 ± 29 months; APT, 63 ± 27 months). The APT group was older (average age: APT2, 70 years; MBT, 64.7 years) and had a lower BMI than the MBT group (APT2, 30.8; MBT, 33.8).Results Survivorship, as defined by revision for any reason, was 99% for the APT group and 97% for the MBT group. There were four (2%) tibial failures in the MBT group in patients with a BMI of greater than 40. There were no revisions for loosening or osteolysis in the APT group. Conclusion APT implants perform as well as MBT implants in a non-age-or activity-selected TKA population with a BMI of less than 37.5. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

All-polyethylene and Metal-backed Tibial Components Are Equivalent With BMI of Less Than 37.5

Toman¹,

Iorio²,

Healy³

2012

Clinical Orthopaedics &Amp; Related Research

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“…Candidates for all-polyethylene tibial TKAs mainly are patients considered low demand, such as the elderly (older than 70 years) or patients with rheumatoid arthritis [25,31]. Nonetheless, the all-polyethylene tibial component also has been recommended for younger patients [9,36].…”

Section: Introductionmentioning

confidence: 99%

All-polyethylene Tibial Components are Equal to Metal-backed Components: Systematic Review and Meta-regression

Nouta

Verra

Pijls

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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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 metalbacked 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. Metaregression showed strong evidence that the all-polyethylene design has improved with time compared with the metalbacked 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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“…A két típus árában és indikációjában jelentős kü -lönb ségek vannak. Bettinson és munkatársai 16 tízéves, randomizált vizsgálatokat végeztek az all-poly és fémtálcás protézisek esetén. A hoszszú távú, 10 éves kilazulás tekintetében kétirá-nyú, hagyományos röntgenfelvételek és fi zikai vizsgálatok alapján nem találtak szignifi káns különbséget.…”

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Radiostereometric analysis for measuring tibial component migration. Early results

Kiss-Polauf¹,

Illyés²,

Havasi³

et al. 2013

Biomech Hung

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AbsztraktBevezetés: A Szent János Kórház Ortopéd-Traumatológiai Osztályán az UmRSA marker alapú radiosztereometriai családba tartozó analitikai módszer használatával 2009-ben kezdődött meg az all-poly és fémtálcás térdízületi endoprotézis beültetések migrációjának korai és késői után-követése. A cikk célja a korai eredményeik összefoglalása. Anyag és módszer:A térdízületi endoprotézis beültetés 5 esetben -4 all-poly, 1 fémtálcás proté-zissel -a hagyományos műtéti technikával történt. A vizsgált protézisek környezetébe, valamint az insertbe tantalum jelzőgolyókat lőttünk. A műtétet követően 3, 6, 12 havonta, ezt követően évente végeztünk marker alapú radiosztereometriai vizsgálatot. Az UmRSA rendszerhez kifejlesztett feldolgozó programok segítségével határoztuk meg a térdízületi protézisek migrációját a tér mindhárom irányába.Eredmények: Az all-poly komponensek átlagos éves térbeli elmozdulása 0,0676 mm, a fém-tálcásé 0,2143 mm, ami megfelel a nemzetközi adatoknak. A kétféle tibialis komponens három-dimenziós migrációja esetében csak a fémtálcás komponensnél tapasztaltunk cranialis és mediá-lis elmozdulást.Következtetés: A tibialis komponens migrációjának vizsgálatánál eredményeink korrelálnak a nemzetközi irodalommal. A kétféle tibialis komponens 3D migrációjának jellegzetességei között lényeges különbségek lehetnek.Kulcsszavak: radiosztereometriai analízis, RSA, térdprotézis migráció, tibialis komponens, protézislazulás Radiostereometric analysis for measuring tibial component migration. Early results AbstractThe authors carry out radiostereometric measurements since 2006 at Szent János Hospital, Budapest. The follow-up study started in 2009 to investigate the migration of all-polyethylene and metal-backed tibial components in total knee arthroplasty. Authors publish below their early results from the fi rst three years.

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All-Polyethylene Compared with Metal-Backed Tibial Components in Total Knee Arthroplasty at Ten Years

Abstract: The long-term results demonstrate excellent survivorship, with revision as the end point, for both the metal-backed and the all-polyethylene tibial component designs with no differences noted between the two.

Cited by 61 publications

References 19 publications

All-polyethylene and Metal-backed Tibial Components Are Equivalent With BMI of Less Than 37.5

All-polyethylene and Metal-backed Tibial Components Are Equivalent With BMI of Less Than 37.5

All-polyethylene Tibial Components are Equal to Metal-backed Components: Systematic Review and Meta-regression

Radiostereometric analysis for measuring tibial component migration. Early results

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