nach oben

Clinical Orthopaedics and Related Research®

Erschienen in:

01.12.2012 | Survey

All-polyethylene Tibial Components are Equal to Metal-backed Components: Systematic Review and Meta-regression

verfasst von: Klaas Auke Nouta, MD, Wiebe C. Verra, MD, Bart G. Pijls, MD, Jan W. Schoones, MA, Rob G. H. H. Nelissen, MD, PhD

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 12/2012

Einloggen, um Zugang zu erhalten

Abstract

Background

Less than 1% of all primary TKAs are performed with an all-polyethylene tibial component, although recent studies indicate all-polyethylene tibial components are equal to or better than metal-backed ones.

Questions/purposes

We asked whether the metal-backed tibial component was clinically superior to the all-polyethylene tibial component in primary TKAs regarding revision rates and clinical functioning, and which modifying variables affected the revision rate.

Methods

We systematically reviewed the literature for clinical studies comparing all-polyethylene and metal-backed tibial components used in primary TKAs in terms of revision rates, clinical scores, and radiologic parameters including radiostereometric analysis (RSA). Meta-regression techniques were used to explore factors modifying the observed effect. Our search yielded 1557 unique references of which 26 articles were included, comprising more than 12,500 TKAs with 231 revisions for any reason.

Results

Meta-analysis showed no differences between the all-polyethylene and metal-backed components except for higher migration of the metal-backed components. Meta-regression showed strong evidence that the all-polyethylene design has improved with time compared with the metal-backed design.

Conclusions

The all-polyethylene components were equivalent to metal-backed components regarding revision rates and clinical scores. The all-polyethylene components had better fixation (RSA) than the metal-backed components. The belief that metal-backed components are better than all-polyethylene ones seems to be based on studies from earlier TKAs. This might no longer be true for modern TKAs.

Level of Evidence

Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Adalberth G, Nilsson KG, Bystrom S, Kolstad K, Milbrink J. Low-conforming all-polyethylene tibial component not inferior to metal-backed component in cemented total knee arthroplasty: prospective, randomized radiostereometric analysis study of the AGC total knee prosthesis. J Arthroplasty. 2000;15:783–792.PubMedCrossRef

Adalberth G, Nilsson KG, Bystrom S, Kolstad K, Milbrink J. All-polyethylene versus metal-backed and stemmed tibial components in cemented total knee arthroplasty: a prospective, randomised RSA study. J Bone Joint Surg Br. 2001;83:825–831.PubMedCrossRef

Albrektsson BE, Ryd L, Carlsson LV, Freeman MA, Herberts P, Regner L, Selvik G. The effect of a stem on the tibial component of knee arthroplasty: a roentgen stereophotogrammetric study of uncemented tibial components in the Freeman-Samuelson knee arthroplasty. J Bone Joint Surg Br. 1990;72:252–258.PubMed

Apel DM, Tozzi JM, Dorr LD. Clinical comparison of all-polyethylene and metal-backed tibial components in total knee arthroplasty. Clin Orthop Relat Res. 1991;273:243–252.PubMed

Australian Orthopaedic Association. Australian National Joint Registry. Available at: http://www.dmac.adelaide.edu.au/aoanjrr/. Accessed August 18, 2011.

Bek J, Vavrik P, Landor I. [Evaluation of the survival of the Walter-Motorlet TKA: long-term outcomes] [in Czech]. Acta Chir Orthop Traumatol Cech. 2005;72:221–227.PubMed

Berend ME, Ritter MA, Hyldahl HC, Meding JB, Redelman R. Implant migration and failure in total knee arthroplasty is related to body mass index and tibial component size. J Arthroplasty. 2008;23(6 suppl 1):104–109.PubMedCrossRef

Berend ME, Ritter MA, Meding JB, Faris PM, Keating EM, Pierce A. Clinical results of isolated tibial component revisions with femoral component retention. J Arthroplasty. 2008;23:61–64.PubMedCrossRef

Bettinson KA, Pinder IM, Moran CG, Weir DJ, Lingard EA. All-polyethylene compared with metal-backed tibial components in total knee arthroplasty at ten years: a prospective, randomized controlled trial. J Bone Joint Surg Am. 2009;91:1587–1594.PubMedCrossRef

10.

Boutron I, Moher D, Tugwell P, Giraudeau B, Poiraudeau S, Nizard R, Ravaud P. A checklist to evaluate a report of a nonpharmacological trial (CLEAR NPT) was developed using consensus. J Clin Epidemiol. 2005;58:1233–1240.PubMedCrossRef

11.

Colditz GA, Brewer TF, Berkey CS, Wilson ME, Burdick E, Fineberg HV, Mosteller F. Efficacy of BCG vaccine in the prevention of tuberculosis: meta-analysis of the published literature. JAMA. 1994;271:698–702.PubMedCrossRef

12.

Dalury DF, Tucker KK, Kelley TC. All-polyethylene tibial components in obese patients are associated with low failure at midterm followup. Clin Orthop Relat Res. 2012;470:117–124.PubMedCrossRef

13.

Dojcinovic S, Ait Si ST, Servien E, Verdonk PC, Neyret P. [A comparison of all-polyethylene and metal-backed tibial components in total knee arthroplasty] [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2007;93:364–372.

14.

Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56:455–463.PubMedCrossRef

15.

Faris PM, Ritter MA, Keating EM, Meding JB, Harty LD. The AGC all-polyethylene tibial component: a ten-year clinical evaluation. J Bone Joint Surg Am. 2003;85:489–493.PubMed

16.

Font-Rodriguez DE, Scuderi GR, Insall JN. Survivorship of cemented total knee arthroplasty. Clin Orthop Relat Res. 1997;345:79–86.PubMedCrossRef

17.

Forster MC. Survival analysis of primary cemented total knee arthroplasty: which designs last? J Arthroplasty. 2003;18:265–270.PubMedCrossRef

18.

Gioe TJ, Maheshwari AV. The all-polyethylene tibial component in primary total knee arthroplasty. J Bone Joint Surg Am. 2010;92:478–487.PubMedCrossRef

19.

Gioe TJ, Stroemer ES, Santos ER. All-polyethylene and metal-backed tibias have similar outcomes at 10 years: a randomized level I [corrected] evidence study. Clin Orthop Relat Res. 2007;455:212–218.PubMedCrossRef

20.

Hungerford DS, Krackow KA. Total joint arthroplasty of the knee. Clin Orthop Relat Res. 1985;192:23–33.PubMed

21.

Hyldahl H, Regner L, Carlsson L, Karrholm J, Weidenhielm L. All-polyethylene vs. metal-backed tibial component in total knee arthroplasty-a randomized RSA study comparing early fixation of horizontally and completely cemented tibial components. Part 1. Horizontally cemented components: AP better fixated than MB. Acta Orthop. 2005;76:769–777.PubMedCrossRef

22.

Hyldahl H, Regner L, Carlsson L, Karrholm J, Weidenhielm L. All-polyethylene vs. metal-backed tibial component in total knee arthroplasty-a randomized RSA study comparing early fixation of horizontally and completely cemented tibial components. Part 2. Completely cemented components: MB not superior to AP components. Acta Orthop. 2005;76:778–784.PubMedCrossRef

23.

Johnston L, MacLennan G, McCormack K, Ramsay C, Walker A. The Knee Arthroplasty Trial (KAT) design features, baseline characteristics, and two-year functional outcomes after alternative approaches to knee replacement. J Bone Joint Surg Am. 2009;91:134–141.PubMedCrossRef

24.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6:e1000100.PubMedCrossRef

25.

L’Insalata JL, Stern SH, Insall JN. Total knee arthroplasty in elderly patients: comparison of tibial component designs. J Arthroplasty. 1992;7:261–266.PubMedCrossRef

26.

Ma HM, Lu YC, Ho FY, Huang CH. Long-term results of total condylar knee arthroplasty. J Arthroplasty. 2005;20:580–584.PubMedCrossRef

27.

Muller SD, Deehan DJ, Holland JP, Outerside SE, Kirk LM, Gregg PJ, McCaskie AW. Should we reconsider all-polyethylene tibial implants in total knee replacement? J Bone Joint Surg Br. 2006;88:1596–1602.PubMed

28.

Najibi S, Iorio R, Surdam JW, Whang W, Appleby D, Healy WL. All-polyethylene and metal-backed tibial components in total knee arthroplasty: a matched pair analysis of functional outcome. J Arthroplasty. 2003;18(7 suppl 1):9–15.PubMedCrossRef

29.

Nelissen RG, Valstar ER, Rozing PM. The effect of hydroxyapatite on the micromotion of total knee prostheses: a prospective, randomized, double-blind study. J Bone Joint Surg Am. 1998;80:1665–1672.PubMed

30.

Norgren B, Dalen T, Nilsson KG. All-poly tibial component better than metal-backed: a randomized RSA study. Knee. 2004;11:189–196.PubMedCrossRef

31.

Nouta KA, Pijls BG, Nelissen RG. All-polyethylene tibial components in TKA in rheumatoid arthritis: a 25-year follow-up study. Int Orthop. 2012;36:565–570.PubMedCrossRef

32.

O’Rourke MR, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC. Osteolysis associated with a cemented modular posterior-cruciate-substituting total knee design: five to eight-year follow-up. J Bone Joint Surg Am. 2002;84:1362–1371.PubMed

33.

Pagnano MW, Trousdale RT, Stuart MJ, Hanssen AD, Jacofsky DJ. Rotating platform knees did not improve patellar tracking: a prospective, randomized study of 240 primary total knee arthroplasties. Clin Orthop Relat Res. 2004;428:221–227.PubMedCrossRef

34.

Pijls BG, Dekkers OM, Middeldorp S, Valstar ER, Van der Heide HJ, Van der Linden-Van der Zwaag HM, Nelissen RG. AQUILA: Assessment of QUality in Lower limb Arthroplasty: an expert Delphi consensus for total knee and total hip arthroplasty. BMC Musculoskelet Disord. 2011;12:173.PubMedCrossRef

35.

Railton GT, Waterfield A, Nunn D, Freeman MA. The effect of a metal-back without a stem upon the fixation of a tibial prosthesis. J Arthroplasty. 1990;5(suppl):S67–S71.PubMedCrossRef

36.

Ranawat AS, Mohanty SS, Goldsmith SE, Rasquinha VJ, Rodriguez JA, Ranawat CS. Experience with an all-polyethylene total knee arthroplasty in younger, active patients with follow-up from 2 to 11 years. J Arthroplasty. 2005;20(7 suppl 3):7–11.PubMedCrossRef

37.

Rand JA. Comparison of metal-backed and all-polyethylene tibial components in cruciate condylar total knee arthroplasty. J Arthroplasty. 1993;8:307–313.PubMedCrossRef

38.

Regner L, Carlsson L, Karrholm J, Herberts P. Clinical and radiologic survivorship of cementless tibial components fixed with finned polyethylene pegs. J Arthroplasty. 1997;12:751–758.PubMedCrossRef

39.

Ritter MA. The cemented all-poly tibia. Orthopedics. 1994;17:841.PubMed

40.

Robinson RP. The early innovators of today’s resurfacing condylar knees. J Arthroplasty. 2005;20(1 suppl 1):2–26.PubMedCrossRef

41.

Robinson RP, Green TM. Eleven-year implant survival rates of the all-polyethylene and metal-backed modular Optetrak Posterior Stabilized Knee in bilateral simultaneous cases. J Arthroplasty. 2011;26:1165–1169.PubMedCrossRef

42.

Rodriguez JA, Baez N, Rasquinha V, Ranawat CS. Metal-backed and all-polyethylene tibial components in total knee replacement. Clin Orthop Relat Res. 2001;392:174–183.PubMedCrossRef

43.

Ryd L, Albrektsson BE, Carlsson L, Dansgard F, Herberts P, Lindstrand A, Regnér L, Toksvig-Larsen S. Roentgen stereophotogrammetric analysis as a predictor of mechanical loosening of knee prostheses. J Bone Joint Surg Br. 1995;77:377–383.PubMed

44.

Shen B, Yang J, Zhou Z, Kang P, Wang L, Pei F. Survivorship comparison of all-polyethylene and metal-backed tibial components in cruciate-substituting total knee arthroplasty: Chinese experience. Int Orthop. 2009;33:1243–1247.PubMedCrossRef

45.

Udomkiat P, Dorr LD, Long W. Matched-pair analysis of all-polyethylene versus metal-backed tibial components. J Arthroplasty. 2001;16:689–696.PubMedCrossRef

46.

Valstar ER, Gill R, Ryd L, Flivik G, Borlin N, Karrholm J. Guidelines for standardization of radiostereometry (RSA) of implants. Acta Orthop. 2005;76:563–572.PubMedCrossRef

47.

Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Software. 2010;36:1–48.

48.

Vochteloo AJ, Pijls BG, van der Heide HJ. Sutures v staples: let’s add three other studies. BMJ. 2010;340:c2627.PubMedCrossRef

49.

Wright RW, Brand RA, Dunn W, Spindler KP. How to write a systematic review. Clin Orthop Relat Res. 2007;455:23–29.PubMedCrossRef

Titel: All-polyethylene Tibial Components are Equal to Metal-backed Components: Systematic Review and Meta-regression
verfasst von: Klaas Auke Nouta, MD
Wiebe C. Verra, MD
Bart G. Pijls, MD
Jan W. Schoones, MA
Rob G. H. H. Nelissen, MD, PhD
Publikationsdatum: 01.12.2012
Verlag: Springer-Verlag
Erschienen in: Clinical Orthopaedics and Related Research® / Ausgabe 12/2012
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-012-2582-2

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Aquatherapie bei Fibromyalgie wirksamer als Trockenübungen

03.05.2024 Fibromyalgiesyndrom Nachrichten

Bewegungs-, Dehnungs- und Entspannungsübungen im Wasser lindern die Beschwerden von Patientinnen mit Fibromyalgie besser als das Üben auf trockenem Land. Das geht aus einer spanisch-brasilianischen Vergleichsstudie hervor.

Endlich: Zi zeigt, mit welchen PVS Praxen zufrieden sind

IT für Ärzte Nachrichten

Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärztinnen und Psychotherapeuten.

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 12/2012

Hip Ontogenesis: How Evolution, Genes, and Load History Shape Hip Morphotype and Cartilotype

Pelvic Morphology Differs in Rotation and Obliquity Between Developmental Dysplasia of the Hip and Retroversion

Erratum to: MRI of Hip Cartilage: Joint Morphology, Structure, and Composition

MRI of Hip Cartilage: Joint Morphology, Structure, and Composition

The Natural Progression of Adult Elbow Osteonecrosis Related To Corticosteroid Treatment