Comparative Survivorship of Different Tibial Designs in Primary Total Knee Arthroplasty

Kremers, Hilal Maradit; Sierra, Rafael J.; Schleck, Cathy D.; Berry, Daniel J.; Cabanela, Miguel E.; Hanssen, Arlen D.; Pagnano, Mark W.; Trousdale, Robert T.; Lewallen, David G.

doi:10.2106/jbjs.m.00820

Cited by 57 publications

(27 citation statements)

References 32 publications

(38 reference statements)

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“…27 A large single centre retrospective study recently reported that allpolyethylene tibial components had a significantly lower risk of revision compared with metal-backed modular implants, (hazard ratio, 0.3; 95% CI 0.2 to 0.5; p < 0.0001) and therefore were associated with a better outcome. 60 The authors also reported that in metal-backed modular tibial designs, unconstrained TKA performed better than the posterior-stabilised TKA (p = 0.002), which is consistent with registry findings.…”

Section: Implant Designsupporting

confidence: 77%

The epidemiology of failure in total knee arthroplasty

Khan

Osman

Green

et al. 2016

The Bone & Joint Journal

250

166

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Total knee arthroplasty (TKA) is a cost effective and extremely successful operation. As longevity increases, the demand for primary TKA will continue to rise. The success and survivorship of TKAs are dependent on the demographics of the patient, surgical technique and implant-related factors. Currently the risk of failure of a TKA requiring revision surgery ten years post-operatively is 5%. The most common indications for revision include aseptic loosening (29.8%), infection (14.8%), and pain (9.5%). Revision surgery poses considerable clinical burdens on patients and financial burdens on healthcare systems. We present a current concepts review on the epidemiology of failed TKAs using data from worldwide National Joint Registries.

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Section: Implant Designsupporting

confidence: 77%

The epidemiology of failure in total knee arthroplasty

Khan

Osman

Green

et al. 2016

The Bone & Joint Journal

250

166

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“…The hazard ratio for APT revision was 0.3 (95% CI, 0.2-0.5) compared with MBTrevision. 15 In a prospective study utilizing a 14-year community registry of over 14,500 operations, the APT revision rate was 1% with a mean time to follow-up of 66.3 months, while the MBT revision rate was 4.9% with a mean of 62.9 months of follow-up. After hazard ratio calculation, there was no difference in revision risk between the two groups.…”

Section: Metal-backed Tibial Componentsmentioning

confidence: 99%

All-Polyethylene versus Metal-Backed Tibial Components in Total Knee Arthroplasty

et al. 2019

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All-polyethylene tibial (APT) implants were incorporated into the initial design of the first total knee arthroplasty (TKA) systems. Since then, a dynamic shift has taken place and metal-backed tibial (MBT) implants have become the gold standard in TKA. This has mostly been due to the theoretical advantages of intraoperative flexibility and improved biomechanics in addition to the heavy influence of device manufacturers. MBT implant comes not only with a higher cost but also with potential for complications such as osteolysis, backside wear, and thinning of the polyethylene insert, which were not previously seen with APT implant. The majority of studies comparing APT and MBT implants have shown no difference in clinical outcomes and survivorship. Newer studies from the past decade have begun highlighting the economic advantages of APT implant, especially in patients undergoing primary, uncomplicated TKA. Use of APT implants in younger patients and those with a body mass index > 35 has not been extensively studied, but the existing literature suggests the use of APT implant in these cohorts to be equally as acceptable. With modern implant design and instrumentation, rising utilization of TKA along with current and future economic strain on health care, the increased use of APT implant could result in massive savings without sacrificing positive patient outcomes.

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“…In the majority of studies, men have at least a 1.5 to 2-fold higher risk of aseptic revisions than women 3,4,14,15,17 . Yet this is not a universal finding.…”

Section: Demographic Factorsmentioning

confidence: 99%

Clinical Factors, Disease Parameters, and Molecular Therapies Affecting Osseointegration of Orthopedic Implants

et al. 2016

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Total hip and knee arthroplasty are effective interventions for management of end-stage arthritis. Indeed, about 7 million Americans are currently living with artificial hip and knee joints. The majority of these individuals, however, will outlive their implants and require revision surgeries, mostly due to poor implant osseointegration and aseptic loosening. Revisions are potentially avoidable with better management of patient-related risk factors that affect the osseointegration of orthopedic implants. In this review, we summarize the published clinical literature on the role of demographics, biologic factors, comorbidities, medications and aseptic loosening risk. We focus on several systemic and local factors that are particularly relevant to implant osseointegration. Examples include physiological and molecular processes that are linked to hyperglycemia, oxidative stress, metabolic syndrome and dyslipidemia. We discuss how orthopedic implant osseointegration can be affected by a number of molecular therapies that are antiresorptive or bone anabolic (i.e. calcium, vitamin D, bisphosphonates, calcitonin, strontium, hormone replacement therapy, selective estrogen-receptor modulators).

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Comparative Survivorship of Different Tibial Designs in Primary Total Knee Arthroplasty

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 57 publications

References 32 publications

The epidemiology of failure in total knee arthroplasty

The epidemiology of failure in total knee arthroplasty

All-Polyethylene versus Metal-Backed Tibial Components in Total Knee Arthroplasty

Clinical Factors, Disease Parameters, and Molecular Therapies Affecting Osseointegration of Orthopedic Implants

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