Comparable results between crosslinked polyethylene and conventional ultra-high molecular weight polyethylene implanted in total knee arthroplasty: systematic review and meta-analysis of randomised clinical trials

Abstract

Purpose Total knee arthroplasty (TKA) has experienced exponential growth over the last decade, including increasingly younger patients with high functional demands. Highly crosslinked polyethylene (HXLPE) has been proven effective in reducing osteolysis and loosening revisions while improving long-term survival and performance in total hip arthroplasty; nevertheless, this superiority is not demonstrated in TKA. The aim of this systematic review and meta-analysis was to examine whether HXLPE improved overall survival and postoperative functional and radiological outcomes compared to conventional polyethylene (CPE) in TKA. Methods According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, a literature search of five databases (PubMed, Medline, Scopus, Science Direct and Embase) was made. A PICOS model was performed. The initial screening identified 2541 studies. Each eligible clinical article was analysed according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence (LoE). Only randomised clinical trials (RCTs) of LoE 1 and 2 were included. The methodological quality of the articles was assessed using the Risk of Bias 2 (RoB 2) tool. Results Six clinical studies were included in the final study. This systematic review and meta-analysis were registered on the International Prospective Register of Systematic Reviews (PROSPERO). A total of 2285 knees were included. Eight outcomes (total reoperations, reoperations for prosthesis loosening and infections, radiolucent lines, osteolysis, mechanical failure, postoperative KSS knee score and function score) were analysed. For none of them, a statistically significant difference was found about the superiority of HXLPE over CPE (p > 0.05). Conclusions There were no statistically significant differences between HXLPE and CPE for TKA concerning clinical, radiological, and functional outcomes; nevertheless, HXLPE did not show higher failure rates or complications and can be safely used for TKA. Level of evidence II.

Impact of patient and prosthesis characteristics on common reasons for total knee replacement revision: a registry study of 36,626 revision cases from Australia, Sweden, and USA

“…UHMWPE showed higher odds for revision for loosening than XLPE, while there was a greater risk with PS and MB designs. Previous studies have been variable, with some showing no difference between “conventional” polyethylene and XLPE ( 37 ), while others report findings similar to ours that may relate to biological reactions to wear products ( 16 ). Osteolysis may also be a common mechanism to explain the association of loosening with PS and MB components ( 21 , 38 ), which others claim relates simply to component design ( 39 ).…”

No Significant Differences in Clinical and Radiographic Outcomes between PCL Retained or Sacrificed Kinematic Aligned Medial Pivot Total Knee Arthroplasty in Varus Knee

“…Among them, sociodemographic, preoperative, intraoperative, and postoperative factors should be considered [ 5 , 6 ]. Several materials and surgical techniques have been introduced into clinical practice to improve patient satisfaction and long-term clinical and functional outcomes [ 7 , 8 , 9 , 10 , 11 ].…”

Tibial Derotational Osteotomy for Patellofemoral Instability: A Systematic Review

“…The PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines were used to report the process of article selection [ 20 ]. These guidelines have been used in prior similarly designed studies [ 21 ].…”