Highly Cross-Linked Versus Conventional Polyethylene in Posterior-Stabilized Total Knee Arthroplasty at a Mean 5-Year Follow-up

Meneghini, R. Michael; Lovro, Luke R.; Smits, Shelly; Ireland, Philip H.

doi:10.1016/j.arth.2015.05.009

Cited by 28 publications

(10 citation statements)

References 20 publications

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“…Of the seven revision surgeries to TKA at 5 years postoperatively in our cohort, only one of these surgeries was secondary to component loosening, but even in this patient there was no evidence of catastrophic failure of the components. These are consistent with the clinical and radiographic results reported with this X3 polyethylene in posterior stabilized TKA knees by Meneghini et al 11 They showed that at 5 years follow-up, there were similar functional outcomes and revision rates of X3 polyethylene (n ¼ 64) compared with conventional polyethylene (n ¼ 50). There were no revisions for aseptic loosening or mechanical failure shown in either group.…”

Section: Discussionsupporting

confidence: 90%

Evaluation of Safety and Medium-Term Functional Outcomes of a Medial Fixed-Bearing Unicompartmental Knee Arthroplasty with Ultra-Highly Cross-Linked Polyethylene

et al. 2020

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The primary objective of this study was to evaluate the in vivo safety of a unicompartmental knee arthroplasty design with sequentially annealed cross-linked polyethylene by evaluating reoperation rate, in particular those related to excessive polyethylene wear or breakage. The secondary objective was to examine functional outcomes via standardized questionnaires. This was a 5-year institutional review board-approved prospective single-surgeon case series of the first 152 consecutive patients with symptomatic medial unicompartmental osteoarthritis implanted with a partial knee replacement between May 2010 and December 2014. Study participants were asked to complete the Knee injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthrtis Index (WOMAC) questionnaires at preoperation and 2 to 5 years postoperation. Major complications and all reoperations were recorded and we produced Kaplan–Meier survivorship curves with the end point of revision to TKA. Pre- and postoperative differences for KOOS and WOMAC were evaluated by paired t-tests. The median length of follow-up was 7.2 (0–9.72) years. Seven patients required revision surgery to TKA (4.9% of patients): four with progression of arthritis in other compartments, two for infection, and one for loosening of the femoral component and subsequent progression of pain. There were no failures of polyethylene. Survival of cohort was 99.3 and 97.9% at 2 and 5 years, respectively. Patients significantly improved (p-value < 0.001) between preoperative assessment and at 2 years, with no decline at 5 years postoperation. These preliminary midterm results with this fixed-bearing design and cross-linked polyethylene were encouraging with no catastrophic failures of polyethylene. Patient reported outcomes were significantly improved and revision rates were acceptable and lower than registry reported results.

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Section: Discussionsupporting

confidence: 90%

Evaluation of Safety and Medium-Term Functional Outcomes of a Medial Fixed-Bearing Unicompartmental Knee Arthroplasty with Ultra-Highly Cross-Linked Polyethylene

et al. 2020

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“…Zimmer) 2 years 0 CP 113 71.1 ± 7.3 20/93 NS Net-shape molding of GUR 1050 resin and sterilized by gamma radiation in nitrogen at a dose of 37 kGy. 0 Lachiewicz and Soileau 2015 [ 19 ] RCT XLPE 110 68 ± 10 35/75 31 Electron beam, 6.5 CGy irradiated in nitrogen, remelted to quench the free radicals; then sterilized by ethylene oxide Zimmer, Inc, Warsaw, IN, USA Minimum 2 years 14 CP 122 70 ± 10 37/85 31 Gamma-irradiated in nitrogen 21 Meneghini et al 2015 [ 20 ] PCT XLPE 64 63.8 18/29 31.5 GUR 1020 UHMWPE and cross-linking was performed with a cycled process of gamma-irradiation at 30 kGy followed by annealing at 130 °C for 8 h, which was repeated 3 times sequentially Posterior-substituting single-radius design (Triathlon; Stryker, Mahwah, NJ) 5.2 years (range, 4.3–5.8 years). 10 CP 50 67.3 12/25 31.1 Compression-molded GU 1020 UHMWPE, packed in nitrogen and gamma-irradiated at 30 kGy.…”

Section: Methodsmentioning

confidence: 99%

Cross-linked versus conventional polyethylene for total knee arthroplasty: a meta-analysis

Gao

Wang

et al. 2016

J Orthop Surg Res

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BackgroundHighly cross-linked polyethylene (HXLPE) has been reported as an effective material for decreasing polyethylene wear and osteolysis in total knee arthroplasty (TKA). Because no single study to date has been large enough to definitively determine the benefit of HXLPE in TKA, we conducted a meta-analysis to pool the results from randomized controlled trials (RCTs) and non-RCTs to make such a determination.MethodsPotential candidate articles were identified by searching the Cochrane Library, Medline (1966-2015.10), PubMed (1966-2015.10), Embase (1980-2015.10), ScienceDirect (1985-2015.10), and other databases. “Gray studies” were identified from the included articles’ reference lists. Pooled data were analyzed using RevMan 5.1.ResultsThree RCTs and three non-RCTs were included in the meta-analysis. There were no significant differences between the groups in the total number of reoperations (P = 0.11), reoperations for prosthesis loosening (P = 0.08), radiolucent line (P = 0.20), osteolysis (P = 0.38), prosthesis loosening (P = 0.10), and mechanical failures related to the tibial polyethylene (P = 1.00). Similarly, no significant differences between the two groups were found in postoperative total knee score (P = 0.18) or functional score (P = 0.23).ConclusionsThe meta-analysis showed that compared with conventional polyethylene, HXLPE did not improve the clinical and radiographic outcomes in mid-term follow-up after TKA. Additional high-quality multicenter prospective RCTs with good design, large study populations and long-term follow-up will be necessary to further clarify the effect of HXLPE in TKA.

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“…Similarly, Sharkey et al [5] found only 3.5% of revisions being performed for polyethylene wear. However, when comparing directly rather than using historical controls, other studies have demonstrated no difference in wear rates comparing conventional and modern polyethylene in TKA [9][10][11].…”

Section: Discussionmentioning

confidence: 98%

Early failure of sequentially annealed polyethylene in total knee arthroplasty

Sonn

Meneghini

2020

Arthroplasty Today

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Improvements in the processing of polyethylene have led to a dramatic reduction in wear rates in total hip arthroplasty. This led to the adoption of modern highly cross-linked polyethylene in total knee arthroplasty (TKA). However, the differences in modes of wear and failure between total hip arthroplasty and TKA have tempered expectations regarding similar decreases in polyethylene-related complications in TKA. We present a case of early catastrophic failure of a modern sequentially irradiated and annealed highly cross-linked polyethylene insert only 5 years after contemporary cementless TKA.

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Highly Cross-Linked Versus Conventional Polyethylene in Posterior-Stabilized Total Knee Arthroplasty at a Mean 5-Year Follow-up

Cited by 28 publications

References 20 publications

Evaluation of Safety and Medium-Term Functional Outcomes of a Medial Fixed-Bearing Unicompartmental Knee Arthroplasty with Ultra-Highly Cross-Linked Polyethylene

Evaluation of Safety and Medium-Term Functional Outcomes of a Medial Fixed-Bearing Unicompartmental Knee Arthroplasty with Ultra-Highly Cross-Linked Polyethylene

Cross-linked versus conventional polyethylene for total knee arthroplasty: a meta-analysis

Early failure of sequentially annealed polyethylene in total knee arthroplasty

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