Use of All-polyethylene Tibial Components in Unicompartmental Knee Arthroplasty Increases the Risk of Early Failure

In Jun Koh; Kyung Hwan Suhl; Min Woo Kim; Man Soo Kim; Keun Young Choi; Yong In

doi:10.1055/s-0036-1597979

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2017; 30(08): 807-815
DOI: 10.1055/s-0036-1597979

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Use of All-polyethylene Tibial Components in Unicompartmental Knee Arthroplasty Increases the Risk of Early Failure

Authors

In Jun Koh

¹Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Republic of Korea

²Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Kyung Hwan Suhl

³Department of Orthopaedic Surgery, Goodmadi Hospital, Incheon, Republic of Korea
Min Woo Kim

⁴Department of Orthopaedic Surgery, Seran General Hospital, Seoul, Republic of Korea
Man Soo Kim

¹Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Republic of Korea
Keun Young Choi

¹Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Republic of Korea
Yong In

¹Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Republic of Korea

²Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

Abstract

All-polyethylene (all-poly) tibial designs in primary total knee arthroplasty (TKA) have been reconsidered with excellent clinical outcomes, survivorship, and cost-effectiveness. However, whether all-poly tibial components provided comparable results to metal-backed modular components during unicompartmental knee arthroplasty (UKA) remains unclear. This study compared the clinical outcomes and prevalence of early failure between all-poly and metal-backed modular components in UKA. We retrospectively reviewed the records and radiographs of 101 consecutive UKAs. In total, 51 UKAs were performed using all-poly tibial components; 50 others used metal-backed modular components. Clinical and radiographic outcomes, adaptive bone remodeling assessed by radiographic bone density, and early failure prevalence rates were compared. Despite a lack of group differences in clinical and radiographic outcomes (p > 0.1 in all comparisons), adaptive bone remodeling at 2 years after surgery of all-poly UKAs was more progressive compared with metal-backed UKAs (1.2 in all-poly UKA group vs. 0.9 in metal-backed UKA group, p < 0.001). In addition, 6 of 51 all-poly UKAs failed within 2 years postoperatively, whereas no metal-backed UKAs failed (11% in all-poly UKA group vs. 0% in metal-backed UKA group, p = 0.027). All-poly tibial component use during UKA increased the risk of early failure, which may be due to a failure in tibial loading distribution.

Keywords

all-polyethylene tibial components - metal-backed modular components - adaptive bone remodeling - unicompartmental knee arthroplasty

Full Text

References

References
1 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
2 Koh IJ, Kim TK, Chang CB, Cho HJ, In Y. Trends in use of total knee arthroplasty in Korea from 2001 to 2010. Clin Orthop Relat Res 2013; 471 (05) 1441-1450
3 Kurtz SM, Ong KL, Schmier J. , et al. Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am 2007; 89 (Suppl. 03) 144-151
4 Gudnason A, Hailer NP, W-Dahl A, Sundberg M, Robertsson O. All- polyethylene versus metal-backed tibial components—an analysis of 27,733 cruciate-retaining total knee replacements from the Swedish knee arthroplasty register. J Bone Joint Surg Am 2014; 96 (12) 994-999
5 Kremers HM, Sierra RJ, Schleck CD. , et al. Comparative survivorship of different tibial designs in primary total knee arthroplasty. J Bone Joint Surg Am 2014; 96 (14) e121
6 Voigt J, Mosier M. Cemented all-polyethylene and metal-backed polyethylene tibial components used for primary total knee arthroplasty: a systematic review of the literature and meta-analysis of randomized controlled trials involving 1798 primary total knee implants. J Bone Joint Surg Am 2011; 93 (19) 1790-1798
7 Cheng T, Pan X, Liu T, Zhang X. Tibial component designs in primary total knee arthroplasty: should we reconsider all-polyethylene component?. Knee Surg Sports Traumatol Arthrosc 2012; 20 (08) 1438-1449
8 Pai SK, Whitwell G, McMurray D, Stewart TD, Stone MH. Long-term results of a total knee prosthesis utilising an all polyethylene tibial component. Arch Orthop Trauma Surg 2013; 133 (08) 1143-1148
9 Browne JA, Gall Sims SE, Giuseffi SA, Trousdale RT. All-polyethylene tibial components in modern total knee arthroplasty. J Am Acad Orthop Surg 2011; 19 (09) 527-535
10 Doran J, Yu S, Smith D, Iorio R. The role of all-polyethylene tibial components in modern TKA. J Knee Surg 2015; 28 (05) 382-389
11 Gioe TJ, Maheshwari AV. The all-polyethylene tibial component in primary total knee arthroplasty. J Bone Joint Surg Am 2010; 92 (02) 478-487
12 Gomoll AH. High tibial osteotomy for the treatment of unicompartmental knee osteoarthritis: a review of the literature, indications, and technique. Phys Sportsmed 2011; 39 (03) 45-54
13 Koh IJ, Kim MW, Kim JH, Han SY, In Y. Trends in high tibial osteotomy and knee arthroplasty utilizations and demographics in Korea from 2009 to 2013. J Arthroplasty 2015; 30 (06) 939-944
14 Riddle DL, Jiranek WA, McGlynn FJ. Yearly incidence of unicompartmental knee arthroplasty in the United States. J Arthroplasty 2008; 23 (03) 408-412
15 Nwachukwu BU, McCormick FM, Schairer WW, Frank RM, Provencher MT, Roche MW. Unicompartmental knee arthroplasty versus high tibial osteotomy: United States practice patterns for the surgical treatment of unicompartmental arthritis. J Arthroplasty 2014; 29 (08) 1586-1589
16 Lustig S, Paillot JL, Servien E, Henry J, Ait Si Selmi T, Neyret P. Cemented all polyethylene tibial insert unicompartimental knee arthroplasty: a long term follow-up study. Orthop Traumatol Surg Res 2009; 95 (01) 12-21
17 Bhattacharya R, Scott CE, Morris HE, Wade F, Nutton RW. Survivorship and patient satisfaction of a fixed bearing unicompartmental knee arthroplasty incorporating an all-polyethylene tibial component. Knee 2012; 19 (04) 348-351
18 Saenz CL, McGrath MS, Marker DR, Seyler TM, Mont MA, Bonutti PM. Early failure of a unicompartmental knee arthroplasty design with an all-polyethylene tibial component. Knee 2010; 17 (01) 53-56
19 Hutt JR, Farhadnia P, Massé V, LaVigne M, Vendittoli PA. A randomised trial of all-polyethylene and metal-backed tibial components in unicompartmental arthroplasty of the knee. Bone Joint J 2015; 97-B (06) 786-792
20 Aleto TJ, Berend ME, Ritter MA, Faris PM, Meneghini RM. Early failure of unicompartmental knee arthroplasty leading to revision. J Arthroplasty 2008; 23 (02) 159-163
21 Ryd L, Lindstrand A, Stenström A, Selvik G. The influence of metal backing in unicompartmental tibial component fixation. An in vivo roentgen stereophotogrammetric analysis of micromotion. Arch Orthop Trauma Surg 1992; 111 (03) 148-154
22 Scott CE, Eaton MJ, Nutton RW, Wade FA, Pankaj P, Evans SL. Proximal tibial strain in medial unicompartmental knee replacements: a biomechanical study of implant design. Bone Joint J 2013; 95-B (10) 1339-1347
23 Simpson DJ, Price AJ, Gulati A, Murray DW, Gill HS. Elevated proximal tibial strains following unicompartmental knee replacement—a possible cause of pain. Med Eng Phys 2009; 31 (07) 752-757
24 Small SR, Berend ME, Ritter MA, Buckley CA, Rogge RD. Metal backing significantly decreases tibial strains in a medial unicompartmental knee arthroplasty model. J Arthroplasty 2011; 26 (05) 777-782
25 Pegg EC, Walter J, Mellon SJ. , et al. Evaluation of factors affecting tibial bone strain after unicompartmental knee replacement. J Orthop Res 2013; 31 (05) 821-828
26 Gillies RM, Hogg MC, Kohan L, Cordingley RL. Adaptive bone remodelling of all polyethylene unicompartmental tibial bearings. ANZ J Surg 2007; 77 (01/02) 69-72
27 Soininvaara TA, Harju KA, Miettinen HJ, Kröger HP. Periprosthetic bone mineral density changes after unicondylar knee arthroplasty. Knee 2013; 20 (02) 120-127
28 Scott CE, Wade FA, Bhattacharya R, MacDonald D, Pankaj P, Nutton RW. Changes in bone density in metal-backed and all-polyethylene medial unicompartmental knee arthroplasty. J Arthroplasty 2016; 31 (03) 702-709
29 Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; (248) 13-14
30 Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 1989; (248) 9-12
31 Koh IJ, Kim MW, Kim MS, Jang SW, Park DC, In Y. The patient's perception does not differ following subvastus and medial parapatellar approaches in total knee arthroplasty: a simultaneous bilateral randomized study. J Arthroplasty 2016; 31 (01) 112-117
32 Kim MS, Koh IJ, Jang SW, Jeon NH, In Y. Two- to four-year follow-up results of total knee arthroplasty using a new high-flexion prosthesis. Knee Surg Relat Res 2016; 28 (01) 39-45
33 Ensini A, Barbadoro P, Leardini A, Catani F, Giannini S. Early migration of the cemented tibial component of unicompartmental knee arthroplasty: a radiostereometry study. Knee Surg Sports Traumatol Arthrosc 2013; 21 (11) 2474-2479
34 Suero EM, Citak M, Njoku IU, Pearle AD. Does the type of tibial component affect mechanical alignment in unicompartmental knee replacement?. Technol Health Care 2013; 21 (01) 81-85
35 Kim SJ, Postigo R, Koo S, Kim JH. Causes of revision following Oxford phase 3 unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014; 22 (08) 1895-1901
36 Lasam MP, Lee KJ, Chang CB, Kang YG, Kim TK. Femoral lateral bowing and varus condylar orientation are prevalent and affect axial alignment of TKA in Koreans. Clin Orthop Relat Res 2013; 471 (05) 1472-1483
37 Han HS, Kang SB. Brief followup report: does high-flexion total knee arthroplasty allow deep flexion safely in Asian patients?. Clin Orthop Relat Res 2013; 471 (05) 1492-1497
38 Barbosa D, de Souza RA, Xavier M, da Silva FF, Arisawa EA, Villaverde AG. Effects of low-level laser therapy (LLLT) on bone repair in rats: optical densitometry analysis. Lasers Med Sci 2013; 28 (02) 651-656