Tibial component designs in primary total knee arthroplasty: should we reconsider all-polyethylene component?

Abstract

Therapeutic study (systematic review and meta-analysis), Level III.

Comparative Survivorship of Different Tibial Designs in Primary Total Knee Arthroplasty

“…Also, some of the confidence intervals were rather wide because of the small number of tibial revisions with certain components. None of the components was associated with a lower risk of revision compared with Howmedica Kinematic Condylar II, a e121(2) 16,2014 component used in the mid-1980s. Of note, the most commonly used all-polyethylene tibial component in this cohort, the PFC Sigma, demonstrated a higher failure rate, but this was based on four tibial revisions (three of which were for wear and loosening) over 7100 person-years of follow-up of >1000 knees.…”

“…Similarly, the risk reduction associated with all-polyethylene components was of similar magnitude in both men and women. Obesity (a BMI of >35 kg/m 2 ) was associated with a higher risk of revision with metal modular tibial components (HR, 1.3; 95% CI: 1.1, 1.5) but not with the 16,2014 polyethylene components. These associations persisted on further adjustment for underlying indications and after excluding the knees with the PFC design.…”

“…D uring an average follow-up interval of 9.4 years after 16,584 primary knee arthroplasties, a total of 1180 revision arthroplasties were performed. There were a total of 374 tibial revisions (309 coincidental femoral revisions) and, of those, 275 tibial revisions were for loosening, wear, and/or osteolysis.…”

“…Finally, we examined whether the difference between cruciate-retaining and posterior-stabilized knees was different 16,2014 in selected subgroups of patients (Fig. 5).…”

“…On the basis of the evidence to date, there is growing consensus that the theoretical advantages of mobile-bearing designs do not necessarily translate into long-term functional and clinical outcomes, and that the less costly all-polyethylene tibial components can successfully be used in many patients with excellent results 16,20,23,27,29 . However, controversy remains about the specific clinical circumstances when modular metal-backed or the all-polyethylene tibial components should be used and the effects of posterior cruciate substitution.…”