Ceramic Coating in Cemented Primary Total Knee Arthroplasty is Not Associated With Decreased Risk of Revision due to Early Prosthetic Joint Infection

Abstract

Background: Prosthetic joint infection (PJI) is one of the most frequent and devastating causes of shortterm revision total knee arthroplasty (TKA). In vitro evidence suggests ceramic surfaces demonstrate resistance to biofilm, but the clinical effect of bearing surface modifications on the risk of PJI remains unclear. This premier registry-based study examines the influence of ceramic bearing surface coatings on the outcome in cemented primary TKA. Methods: In total, 117,660 cemented primary TKAs in patients with primary osteoarthritis recorded in the German arthroplasty registry since 2012 were followed up for a maximum of 3 years. The primary endpoint was risk of revision for PJI on ceramic coated and uncoated cobalt-chromium-molybdenum femoral components. Propensity score matching for age, gender, obesity, diabetes mellitus, depression and Elixhauser comorbidity index, and substratification on common design twins with and without coating was performed. Results: In total, 4637 TKAs (85.1% female) with a ceramic-coated femoral component were identified, 42 had been revised for PJI and 122 for other reasons at 3 years. No survival advantage due to the risk of revision for PJI could be determined for ceramic-coated components. Revision for all other reasons demonstrated a significant higher rate for TKAs with ceramic-coated components. However, the results of this were confounded by a strong prevalence (20.7% vs 0.3%) of metal sensitivity in the ceramic-coated group. Conclusion:No evidence of reduced risk for PJI due to ceramic-coated implants in cemented primary TKA was found. Further analysis for revision reasons other than PJI is required.

Modern Coatings in Knee Arthroplasty

“…Hypoallergenic implants demonstrated higher overall revision rates in the German Arthroplasty Registry after 3 years [89]. In this report, the main differences between coated and standard implant groups were the higher rate of metal allergies in female patients in the coated TKA group.…”

Endoprothesenregister Deutschland (EPRD)

“…So können z. B. alle Implantate mit der gleichen Oberflächenbeschaffenheit als Gruppe analysiert werden [6]. Die Produktdatenbank des ERPD ist inzwischen mit dem NJR harmonisiert und soll zukünftig als Grundlage für eine weltweite und registerübergreifende Datenbank für Implantate der International Society of Arthroplasty Registry (ISAR) dienen.…”

Die Anwendung antiallergisch beschichteter Knieendoprothesen ist mittelfristig sicher

“…Ähnliche Ergebnisse fanden sich auch im EPRD. Auch hier konnte kein Vorteil von beschichteten Implantaten nachgewiesen werden [10]. Die Ursachen für diese höheren Revisionsraten trotz theoretisch besserer Abriebeigenschaften sind unklar.…”

“…Die Ursachen für diese höheren Revisionsraten trotz theoretisch besserer Abriebeigenschaften sind unklar. In der Literatur finden sich jedoch Hinweise, dass Patienten mit und ohne Allergie gegen Implantatmaterialien nicht die gleichen Voraussetzungen aufweisen und somit Allergiepatienten von vornherein ein höheres Revisionsrisiko haben [6,10,22,23]. Insofern kann die Sicherheit einer Implantatbeschichtung nur an vergleichbaren Patienten beurteilt werden, was in dieser Arbeit erfolgt ist.…”