nach oben

Archives of Orthopaedic and Trauma Surgery

Erschienen in:

13.04.2021 | Knee Arthroplasty

Highly cross-linked polyethylene in primary total knee arthroplasty is associated with a lower rate of revision for aseptic loosening: a meta-analysis of 962,467 cases

verfasst von: Ioannis Gkiatas, Theofilos Karasavvidis, Abhinav K. Sharma, William Xiang, Michael-Alexander Malahias, Brian P. Chalmers, Peter K. Sculco

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 6/2022

Einloggen, um Zugang zu erhalten

Abstract

Background

The evolution in total knee arthroplasty (TKA) includes the highly cross-linked polyethylene (HXLPE) which has been reported as an effective manner to reduce the wear of the polyethylene and the osteolysis. The purpose of the present study is to synthesize the results of comparative studies between HXLPE and conventional polyethylenes and determine their effect in primary TKA.

Methods

The US National Library of Medicine (PubMed/MEDLINE) and the Cochrane Database of Systematic Reviews were queried for publications utilizing the following keywords: “cross-linked”, “polyethylene”, “HXLPE”, “conventional”, “total knee arthroplasty”, “TKA”, “total knee replacement” and “TKR” combined with Boolean operators AND and OR.

Results

Ten studies met the inclusion criteria and were included in the present meta-analysis with 962,467 patients. No significant difference was found regarding the revision rate for any reason between the patients who received HXLPE and those with conventional liner (OR 0.67; 95% CI 0.39–1.18; I²: 97.7%). In addition, there was no difference regarding the radiolucent lines between the two types of liners (OR 0.54; 95% CI 0.20–1.49; I²: 69.4%). However, with data coming from seven studies enrolling a total of 411,543 patients, it was demonstrated that patients who received HXLPE were less likely to be revised due to aseptic loosening compared to the patients with conventional liners (OR 0.35; 95% CI 0.31–0.39; I²: 0.0%).

Conclusion

The present meta-analysis showed that regarding the overall revision rate and radiographic outcomes there was no significant difference between the two types of liners. On the other hand, the significantly less revision rate due to loosening supports the routine continued use of HXLPE in primary TKA.

Nur mit Berechtigung zugänglich

Kurtz S (2005) Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Jt Surg Am 87:1487. https://doi.org/10.2106/JBJS.D.02441CrossRef

Sneag DB, Bogner EA, Potter HG (2015) Magnetic resonance imaging evaluation of the painful total knee arthroplasty. Semin Musculoskelet Radiol 19:40–48. https://doi.org/10.1055/s-0034-1396766CrossRefPubMed

Sharkey PF, Lichstein PM, Shen C et al (2014) Why are total knee arthroplasties failing today–has anything changed after 10 years? J Arthroplasty 29:1774–1778. https://doi.org/10.1016/j.arth.2013.07.024CrossRefPubMed

Gunston FH (1971) Polycentric knee arthroplasty: prosthetic simulation of normal knee movement. J Bone Joint Surg Br 53-B:272–277. https://doi.org/10.1302/0301-620X.53B2.272CrossRef

Bracco P, Bellare A, Bistolfi A, Affatato S (2017) Ultra-high molecular weight polyethylene: influence of the chemical, physical and mechanical properties on the wear behavior. Rev Mater 10:791. https://doi.org/10.3390/ma10070791CrossRef

Partridge TCJ, Baker PN, Jameson SS et al (2020) Conventional versus highly cross-linked polyethylene in primary total knee replacement: a comparison of revision rates using data from the national joint registry for England, Wales, and Northern Ireland. J Bone Jt Surg 102:119–127. https://doi.org/10.2106/JBJS.19.00031CrossRef

Kurtz SM (2009) UHMWPE Biomaterials Handbook: Ultra High Molecular Weight Polyethylene in Total Joint Replacement and Medical Devices. Academic Press

Ries MD, Pruitt L (2005) Effect of cross-linking on the microstructure and mechanical properties of ultra-high molecular weight polyethylene. Clin Orthop 440:149–156. https://doi.org/10.1097/01.blo.0000185310.59202.e5CrossRefPubMed

Lachiewicz PF, Geyer MR (2011) The use of highly cross-linked polyethylene in total knee arthroplasty. J Am Acad Orthop Surg 19:143–151. https://doi.org/10.5435/00124635-201103000-00003CrossRefPubMed

10.

Bragdon CR, Doerner M, Martell J et al (2013) The 2012 John Charnley Award: clinical multicenter studies of the wear performance of highly crosslinked remelted polyethylene in THA. Clin Orthop 471:393–402. https://doi.org/10.1007/s11999-012-2604-0CrossRefPubMed

11.

Mall NA, Nunley RM, Zhu JJ et al (2011) The incidence of acetabular osteolysis in young patients with conventional versus highly crosslinked polyethylene. Clin Orthop 469:372–381. https://doi.org/10.1007/s11999-010-1518-yCrossRefPubMed

12.

Calliess T, Ettinger M, Hülsmann N et al (2015) Update on the etiology of revision TKA–evident trends in a retrospective survey of 1449 cases. Knee 22:174–179. https://doi.org/10.1016/j.knee.2015.02.007CrossRefPubMed

13.

Wooley PH, Schwarz EM (2004) Aseptic loosening. Gene Ther 11:402–407. https://doi.org/10.1038/sj.gt.3302202CrossRefPubMed

14.

Abu-Amer Y, Darwech I, Clohisy JC (2007) Aseptic loosening of total joint replacements: mechanisms underlying osteolysis and potential therapies. Arthritis Res Ther 9(Suppl 1):S6. https://doi.org/10.1186/ar2170CrossRefPubMedPubMedCentral

15.

2019 - AOANJRR. https://aoanjrr.sahmri.com/annual-reports-2019. Accessed 10 Sep 2020

16.

Guha AR, Debnath UK, Graham NM (2008) Radiolucent lines below the tibial component of a total knee replacement (TKR)–a comparison between single-and two-stage cementation techniques. Int Orthop 32:453–457. https://doi.org/10.1007/s00264-007-0345-6CrossRefPubMed

17.

Zweymüller KA, Schwarzinger UM, Steindl MS (2006) Radiolucent lines and osteolysis along tapered straight cementless titanium hip stems: a comparison of 6-year and 10-year follow-up results in 95 patients. Acta Orthop 77:871–876. https://doi.org/10.1080/17453670610013150CrossRefPubMed

18.

Sakellariou VI, Sculco P, Poultsides L et al (2013) highly cross-linked polyethylene may not have an advantage in total knee arthroplasty. HSS J® 9:264–269. https://doi.org/10.1007/s11420-013-9352-xCrossRef

19.

Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. https://doi.org/10.1371/journal.pmed.1000097CrossRefPubMedPubMedCentral

20.

Higgins JPT, Altman DG, Gøtzsche PC et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928. https://doi.org/10.1136/bmj.d5928CrossRefPubMedPubMedCentral

21.

Sterne JA, Hernán MA, Reeves BC et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919. https://doi.org/10.1136/bmj.i4919CrossRefPubMedPubMedCentral

22.

Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560. https://doi.org/10.1136/bmj.327.7414.557CrossRefPubMedPubMedCentral

23.

Kim Y-H, Park J-W (2014) Comparison of highly cross-linked and conventional polyethylene in posterior cruciate-substituting total knee arthroplasty in the same patients. JBJS 96:1807–1813. https://doi.org/10.2106/JBJS.M.01605CrossRef

24.

Kindsfater KA, Pomeroy D, Clark CR et al (2015) In vivo performance of moderately crosslinked, thermally treated polyethylene in a prospective randomized controlled primary total knee arthroplasty trial. J Arthroplasty 30:1333–1338. https://doi.org/10.1016/j.arth.2015.02.041CrossRefPubMed

25.

Lachiewicz PF, Soileau ES (2016) Is there a benefit to highly crosslinked polyethylene in posterior-stabilized total knee arthroplasty? a randomized trial. Clin Orthop Relat Res 474:88–95. https://doi.org/10.1007/s11999-015-4241-xCrossRefPubMed

26.

Boyer B, Bordini B, Caputo D et al (2018) Is cross-linked polyethylene an improvement over conventional ultra-high molecular weight polyethylene in total knee arthroplasty? J Arthroplasty 33:908–914. https://doi.org/10.1016/j.arth.2017.10.005CrossRefPubMed

27.

Meneghini RM, Lovro LR, Smits SA, Ireland PH (2015) Highly cross-linked versus conventional polyethylene in posterior-stabilized total knee arthroplasty at a mean 5-year follow-up. J Arthroplasty 30:1736–1739. https://doi.org/10.1016/j.arth.2015.05.009CrossRefPubMed

28.

Hodrick JT, Severson EP, McAlister DS et al (2008) Highly crosslinked polyethylene is safe for use in total knee arthroplasty. Clin Orthop 466:2806–2812. https://doi.org/10.1007/s11999-008-0472-4CrossRefPubMedPubMedCentral

29.

Minoda Y, Aihara M, Sakawa A et al (2009) Comparison between highly cross-linked and conventional polyethylene in total knee arthroplasty. Knee 16:348–351. https://doi.org/10.1016/j.knee.2009.01.005CrossRefPubMed

30.

Takemura S, Minoda Y, Sugama R et al (2019) Comparison of a vitamin E-infused highly crosslinked polyethylene insert and a conventional polyethylene insert for primary total knee arthroplasty at two years postoperatively. Bone Jt J 101-B:559–564. https://doi.org/10.1302/0301-620X.101B5.BJJ-2018-1355.R1CrossRef

31.

de Steiger RN, Muratoglu O, Lorimer M et al (2015) Lower prosthesis-specific 10-year revision rate with crosslinked than with non-crosslinked polyethylene in primary total knee arthroplasty: 386,104 procedures from the Australian Orthopaedic Association National Joint Replacement Registry. Acta Orthop 86:721–727. https://doi.org/10.3109/17453674.2015.1065046CrossRefPubMedPubMedCentral

32.

Yu B, Yang G, Wang W et al (2016) Cross-linked versus conventional polyethylene for total knee arthroplasty: a meta-analysis. J Orthop Surg 11:39. https://doi.org/10.1186/s13018-016-0374-1CrossRef

33.

Jacobs CA, Christensen CP, Greenwald AS, McKellop H (2007) Clinical performance of highly cross-linked polyethylenes in total hip arthroplasty. JBJS 89:2779–2786. https://doi.org/10.2106/JBJS.G.00043CrossRef

34.

Shi J, Zhu W, Liang S et al (2019) Cross-linked versus conventional polyethylene for long-term clinical outcomes after total hip arthroplasty: a systematic review and meta-analysis. J Invest Surg. https://doi.org/10.1080/08941939.2019.1606370CrossRefPubMed

35.

Tsukamoto M, Mori T, Ohnishi H et al (2017) Highly cross-linked polyethylene reduces osteolysis incidence and wear-related reoperation rate in cementless total hip arthroplasty compared with conventional polyethylene at a mean 12-year follow-Up. J Arthroplasty 32:3771–3776. https://doi.org/10.1016/j.arth.2017.06.047CrossRefPubMed

36.

Bradford L, Baker D, Ries MD, Pruitt LA (2004) Fatigue crack propagation resistance of highly crosslinked polyethylene. Clin Orthop 429:68–72. https://doi.org/10.1097/01.blo.0000150124.34906.34CrossRef

37.

Cole JC, Lemons JE, Eberhardt AW (2002) Gamma irradiation alters fatigue-crack behavior and fracture toughness in 1900H and GUR 1050 UHMWPE. J Biomed Mater Res 63:559–566. https://doi.org/10.1002/jbm.10335CrossRefPubMed

38.

Hambright D, Watters T, Kaufman A et al (2010) Fracture of highly cross-linked all-polyethylene patella after total knee arthroplasty. J Knee Surg 23:237–240. https://doi.org/10.1055/s-0031-1271890CrossRefPubMed

39.

Asano T, Akagi M, Clarke IC et al (2007) Dose effects of cross-linking polyethylene for total knee arthroplasty on wear performance and mechanical properties. J Biomed Mater Res B Appl Biomater 83B:615–622. https://doi.org/10.1002/jbm.b.30835CrossRef

40.

Jung KA, Lee SC, Hwang SH, Kim SM (2008) Fracture of a second-generation highly cross-linked UHMWPE tibial post in a posterior-stabilized scorpio knee system. Orthopedics 31:1137–1139. https://doi.org/10.3928/01477447-20081101-10CrossRefPubMed

41.

Diamond OJ, Howard L, Masri B (2018) Five cases of tibial post fracture in posterior stabilized total knee arthroplasty using prolong highly cross-linked polyethylene. Knee 25:657–662. https://doi.org/10.1016/j.knee.2018.05.005CrossRefPubMed

42.

Lee W, Wee L (2019) Highly crosslinked polyethylene tibial post fracture in the unafflicted limb of a patient with unilateral lower limb poliomyelitis: a case report. Malays Orthop J 13:42–44. https://doi.org/10.5704/MOJ.1903.008CrossRefPubMedPubMedCentral

43.

Kim Y-H, Park J-W (2020) Long-term assessment of highly cross-linked and compression-molded polyethylene inserts for posterior cruciate-substituting TKA in young patients: a concise follow-up of a previous report*. J Bone Jt Surg 102:1623–1627. https://doi.org/10.2106/JBJS.20.00261CrossRef

44.

Muratoglu OK, Bragdon CR, O’Connor DO et al (2001) A novel method of cross-linking ultra-high-molecular-weight polyethylene to improve wear, reduce oxidation, and retain mechanical properties. Recipient of the 1999 HAP Paul Award. J Arthroplasty 16:149–160. https://doi.org/10.1054/arth.2001.20540CrossRefPubMed

45.

Kurtz SM, Dumbleton J, Siskey RS et al (2009) Trace concentrations of vitamin E protect radiation crosslinked UHMWPE from oxidative degradation. J Biomed Mater Res A 90:549–563. https://doi.org/10.1002/jbm.a.32122CrossRefPubMed

46.

Gigante A, Bottegoni C, Ragone V, Banci L (2015) Effectiveness of vitamin-E-doped polyethylene in joint replacement: a literature review. J Funct Biomater 6:889–900. https://doi.org/10.3390/jfb6030889CrossRefPubMedPubMedCentral

47.

Muratoglu OK, Bragdon CR, O’Connor DO et al (2002) Aggressive wear testing of a cross-linked polyethylene in total knee arthroplasty. Clin Orthop. https://doi.org/10.1097/00003086-200211000-00015CrossRefPubMed

48.

Muratoglu OK, Burroughs BR, Bragdon CR et al (2004) Knee simulator wear of polyethylene tibias articulating against explanted rough femoral components. Clin Orthop. https://doi.org/10.1097/01.blo.0000143801.41885.8bCrossRefPubMed

49.

Lewis PL, Graves SE, Steiger RN, de et al (2020) Does knee prosthesis survivorship improve when implant designs change? findings from the australian orthopaedic association national joint replacement registry. Clin Orthop 478:1156–1172. https://doi.org/10.1097/CORR.0000000000001229CrossRefPubMedPubMedCentral

50.

Sterne JAC, Sutton AJ, Ioannidis JPA et al (2011) Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ 343:d4002. https://doi.org/10.1136/bmj.d4002CrossRefPubMed

Titel: Highly cross-linked polyethylene in primary total knee arthroplasty is associated with a lower rate of revision for aseptic loosening: a meta-analysis of 962,467 cases
verfasst von: Ioannis Gkiatas
Theofilos Karasavvidis
Abhinav K. Sharma
William Xiang
Michael-Alexander Malahias
Brian P. Chalmers
Peter K. Sculco
Publikationsdatum: 13.04.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 6/2022
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-021-03887-z

Arthropedia

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

Neu im Fachgebiet Orthopädie und Unfallchirurgie

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.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Update Orthopädie und Unfallchirurgie

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

Newsletter bestellen

Springer Medizin

Abstract

Background

Methods

Results

Conclusion

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

Weitere Artikel der Ausgabe 6/2022

Local bone quality measure and construct failure prediction: a biomechanical study on distal femur fractures

Patients’ perceived walking abilities, daily-life gait behavior and gait quality before and 3 months after total knee arthroplasty

Does a skin incision along Langer’s lines reduce complications following fixation of displaced middle-third clavicle fractures?

Radiological maturation and clinical results of double-bundle and single-bundle anterior cruciate ligament reconstruction. A 5-year prospective case-controlled trial

Comparable outcomes of in-cement revision and uncemented modular stem revision for Vancouver B2 periprosthetic femoral fracture at 5 years