Comparison of all‐polyethylene and metal‐backed modular tibial components in endoprosthetic reconstruction of the distal femur

Abstract

Introduction All‐polyethylene (AP) tibial components have demonstrated equivalent or improved long‐term survivorship and reduced cost compared with metal‐backed (MB) components in primary total knee arthroplasty; however, there is a lack of data comparing these outcomes in the setting of an oncologic endoprosthetic reconstruction. Methods A total of 115 (88 AP:27 MB) patients undergoing cemented distal femur endoprosthetic reconstruction following oncologic resection were reviewed. Mean age was 40 years and 51% were females. Cumulative incidences of all‐cause revision, tibial component revision, reoperation, and infection were calculated utilizing a competing risk analysis with death as the competitor. Mean follow‐up was 14 years. Results The 10‐year cumulative incidence of all‐cause revision was 19.9% in the AP group and 16.3% in the MB group (hazard ratio [HR] = 0.93, p = 0.88). The cumulative incidence of tibial component revision was significantly lower in AP compared with MB at 10 years (1.1% vs. 12.5%, HR = 0.18, p = 0.03). There was no difference in infection‐free survival when comparing the two groups (p = 0.72). Conclusions Reconstruction utilizing an MB or AP tibia component resulted in equivalent overall outcome; however, the tibial component in the AP group was less likely to be revised. AP tibial component should be considered for all primary oncologic reconstructions in the distal femur. Level of Evidence Level III Therapeutic.

Clinical outcomes of cemented distal femur replacements with all-polyethylene tibial components for oncologic indications

“…Unlike the femoral component, tibial components are available in both metal and all-polyethylene, and fixation of the tibial component can be achieved in a variety of ways, including cemented, cementless, and hybrid fixation. Despite the increased utilization of DFR with APTs over time, previous studies have paid little attention to the outcomes of tibial components until recently[ 6 , 9 , 20 ]. Bukowski et al [ 20 ] showed that DFRs with APT have a significantly lower incidence of tibial revision at 10 years (1.1% vs 12.5%, HR = 0.18, P = 0.03) and no difference in infection-free survival ( P = 0.72) when compared to the traditional DFR with a metal backed tibia.…”

“…Despite the increased utilization of DFR with APTs over time, previous studies have paid little attention to the outcomes of tibial components until recently[ 6 , 9 , 20 ]. Bukowski et al [ 20 ] showed that DFRs with APT have a significantly lower incidence of tibial revision at 10 years (1.1% vs 12.5%, HR = 0.18, P = 0.03) and no difference in infection-free survival ( P = 0.72) when compared to the traditional DFR with a metal backed tibia.…”

Application and Development of Megaprostheses in Limb Salvage for Bone Tumors Around the Knee Joint

“… 27 Due to differences in tumor site, fixation technique, and type of prosthesis, the incidence of aseptic loosening varies widely among studies, ranging from 0 to 27.5%. 2 , 5 , 22 , 27 - 35 …”

“…27 Due to differences in tumor site, fixation technique, and type of prosthesis, the incidence of aseptic loosening varies widely among studies, ranging from 0 to 27.5%. 2,5,22,[27][28][29][30][31][32][33][34][35] Patients with aseptic loosening are often accompanied by increasing weight-bearing pain, and different degrees of displacement of the prosthesis and the formation of radiolucencies around prosthesis can be seen on the X-ray film. If the aseptic loosening is only visible in the imaging examination and the patient has no obvious symptoms of discomfort, clinician can choose not to intervene.…”

Whole Blood Metal Levels in the Setting of an Oncologic Endoprosthesis: Is There Cause for Concern?

“…Massive endoprostheses have become commonly used for bony reconstruction after oncologic resections of the lower limbs because of their off-the-shelf availability, modularity, and durability [1,5,[9][10][11]. In the United States, these implants are modular and made of cobalt-chromium and titanium alloys [12,20,21].…”