Metal or Modularity: Why do Metal Backed Tibias Have Inferior Outcomes to All-Polyethylene Tibial Components in Patients with Osteoarthritis
Background Biomechanical studies have suggested improved stress distribution in metal-backed (MB) compared to all-polyethylene (AP) tibias, but such potential benefits have not been realized clinically. The purpose of this investigation was to analyze the outcomes of AP components in patients with p...
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| Veröffentlicht in: | The Journal of arthroplasty 2017-03, Vol.32 (3), p.836-842 |
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| container_title | The Journal of arthroplasty |
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| creator | Houdek, Matthew T., MD Watts, Chad D., MD Wyles, Cody C., MD Martin, John R., MD Trousdale, Robert T., MD Taunton, Michael J., MD |
| description | Background Biomechanical studies have suggested improved stress distribution in metal-backed (MB) compared to all-polyethylene (AP) tibias, but such potential benefits have not been realized clinically. The purpose of this investigation was to analyze the outcomes of AP components in patients with primary osteoarthritis and compare the results to those obtained with MB tibial components in total knee arthroplasty (TKA). Methods We reviewed 11,653 patients undergoing primary TKA for osteoarthritis. There were 9,999 (86%) MB (8,470 modular and 1,529 monoblock) and 1,654 (14%) AP tibial components. All patients had at least 2 years of clinical follow-up with mean follow-up of 8 years (range 2-30 years). Results Mean survivorship for all primary TKA’s at the 5-, 10-, 15-, and 20-year time points was 97%, 92%, 86%, and 78%. AP tibial components were found to have improved survivorship when compared to modular and monoblock MB counterparts (P |
| doi_str_mv | 10.1016/j.arth.2016.09.036 |
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The purpose of this investigation was to analyze the outcomes of AP components in patients with primary osteoarthritis and compare the results to those obtained with MB tibial components in total knee arthroplasty (TKA). Methods We reviewed 11,653 patients undergoing primary TKA for osteoarthritis. There were 9,999 (86%) MB (8,470 modular and 1,529 monoblock) and 1,654 (14%) AP tibial components. All patients had at least 2 years of clinical follow-up with mean follow-up of 8 years (range 2-30 years). Results Mean survivorship for all primary TKA’s at the 5-, 10-, 15-, and 20-year time points was 97%, 92%, 86%, and 78%. AP tibial components were found to have improved survivorship when compared to modular and monoblock MB counterparts (P<0.0001). Likewise, AP tibial components were found to have lower rates of tibial component loosening (P<0.0001), tibial osteolysis, and component fracture. Furthermore, the AP group had improved survival rates in most age groups except <55 years where there was no difference. AP tibial components demonstrated improved survival for all BMI groups except in patients with a BMI ≤25 kg/m2 where there was no difference. Conclusion AP tibial components had significantly improved implant survival across all age groups and most BMI categories in patients who underwent TKA for osteoarthritis. Given these outcomes AP tibias are a reasonable option, regardless of patient age and BMI. Level of Evidence Therapeutic Level III</description><identifier>ISSN: 0883-5403</identifier><identifier>EISSN: 1532-8406</identifier><identifier>DOI: 10.1016/j.arth.2016.09.036</identifier><identifier>PMID: 27816367</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; all-polyethylene tibia ; Arthroplasty, Replacement, Knee - instrumentation ; Body Mass Index ; Cartilage Diseases - surgery ; Female ; Humans ; Knee Prosthesis - statistics & numerical data ; Male ; metal-backed tibia ; Minnesota - epidemiology ; modular metal-backed tibia ; monoblock metal-backed tibia ; Orthopedics ; osteoarthritis ; Osteoarthritis - surgery ; Osteoarthritis, Knee - surgery ; outcome ; Polyethylene ; primary total knee arthroplasty ; Prosthesis Design ; Prosthesis-Related Infections - epidemiology ; Reoperation - statistics & numerical data ; Tibia - surgery</subject><ispartof>The Journal of arthroplasty, 2017-03, Vol.32 (3), p.836-842</ispartof><rights>2016</rights><rights>Copyright © 2016. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-844bdcd1ba843c24d24e4dba5ccea07999292a810acc216782b3dec69214d5103</citedby><cites>FETCH-LOGICAL-c411t-844bdcd1ba843c24d24e4dba5ccea07999292a810acc216782b3dec69214d5103</cites><orcidid>0000-0002-7636-0489 ; 0000-0003-0390-1018</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.arth.2016.09.036$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27816367$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Houdek, Matthew T., MD</creatorcontrib><creatorcontrib>Watts, Chad D., MD</creatorcontrib><creatorcontrib>Wyles, Cody C., MD</creatorcontrib><creatorcontrib>Martin, John R., MD</creatorcontrib><creatorcontrib>Trousdale, Robert T., MD</creatorcontrib><creatorcontrib>Taunton, Michael J., MD</creatorcontrib><title>Metal or Modularity: Why do Metal Backed Tibias Have Inferior Outcomes to All-Polyethylene Tibial Components in Patients with Osteoarthritis</title><title>The Journal of arthroplasty</title><addtitle>J Arthroplasty</addtitle><description>Background Biomechanical studies have suggested improved stress distribution in metal-backed (MB) compared to all-polyethylene (AP) tibias, but such potential benefits have not been realized clinically. The purpose of this investigation was to analyze the outcomes of AP components in patients with primary osteoarthritis and compare the results to those obtained with MB tibial components in total knee arthroplasty (TKA). Methods We reviewed 11,653 patients undergoing primary TKA for osteoarthritis. There were 9,999 (86%) MB (8,470 modular and 1,529 monoblock) and 1,654 (14%) AP tibial components. All patients had at least 2 years of clinical follow-up with mean follow-up of 8 years (range 2-30 years). Results Mean survivorship for all primary TKA’s at the 5-, 10-, 15-, and 20-year time points was 97%, 92%, 86%, and 78%. AP tibial components were found to have improved survivorship when compared to modular and monoblock MB counterparts (P<0.0001). Likewise, AP tibial components were found to have lower rates of tibial component loosening (P<0.0001), tibial osteolysis, and component fracture. Furthermore, the AP group had improved survival rates in most age groups except <55 years where there was no difference. AP tibial components demonstrated improved survival for all BMI groups except in patients with a BMI ≤25 kg/m2 where there was no difference. Conclusion AP tibial components had significantly improved implant survival across all age groups and most BMI categories in patients who underwent TKA for osteoarthritis. Given these outcomes AP tibias are a reasonable option, regardless of patient age and BMI. Level of Evidence Therapeutic Level III</description><subject>Aged</subject><subject>all-polyethylene tibia</subject><subject>Arthroplasty, Replacement, Knee - instrumentation</subject><subject>Body Mass Index</subject><subject>Cartilage Diseases - surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Knee Prosthesis - statistics & numerical data</subject><subject>Male</subject><subject>metal-backed tibia</subject><subject>Minnesota - epidemiology</subject><subject>modular metal-backed tibia</subject><subject>monoblock metal-backed tibia</subject><subject>Orthopedics</subject><subject>osteoarthritis</subject><subject>Osteoarthritis - surgery</subject><subject>Osteoarthritis, Knee - surgery</subject><subject>outcome</subject><subject>Polyethylene</subject><subject>primary total knee arthroplasty</subject><subject>Prosthesis Design</subject><subject>Prosthesis-Related Infections - epidemiology</subject><subject>Reoperation - statistics & numerical data</subject><subject>Tibia - surgery</subject><issn>0883-5403</issn><issn>1532-8406</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UstuFDEQtBCIbAI_wAH5yGUGv-aFEFJYAYmUaCMRxNHy2L1ab7zjxfYEzT_ko_EwgQMHTm7JVdXdVY3QK0pKSmj9dl-qkHYly3VJupLw-gla0YqzohWkfopWpG15UQnCT9BpjHtCKK0q8RydsKalNa-bFXq4hqQc9gFfezM6FWya3uHvuwkbj5e_j0rfgcG3trcq4gt1D_hy2EKwmbQZk_YHiDh5fO5ccePdBGk3ORhgYTi89oejH2BIEdsB36hkf9c_bdrhTUzg5y1yXxtfoGdb5SK8fHzP0LfPn27XF8XV5svl-vyq0ILSlLcTvdGG9qoVXDNhmABhelVpDYo0XdexjqmWEqU1o3XTsp4b0HXHqDAVJfwMvVl0j8H_GCEmebBRg3NqAD9GSVveENYJIjKULVAdfIwBtvIY7EGFSVIi5xTkXs7zyzkFSTqZU8ik14_6Y38A85fyx_YMeL8AIG95byHIqLMrGowNoJM03v5f_8M_dO3sYLVydzBB3PsxDNk_SWVkksiv8x3MZ5Cbk7qlDf8FwfevYA</recordid><startdate>20170301</startdate><enddate>20170301</enddate><creator>Houdek, Matthew T., MD</creator><creator>Watts, Chad D., MD</creator><creator>Wyles, Cody C., MD</creator><creator>Martin, John R., MD</creator><creator>Trousdale, Robert T., MD</creator><creator>Taunton, Michael J., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7636-0489</orcidid><orcidid>https://orcid.org/0000-0003-0390-1018</orcidid></search><sort><creationdate>20170301</creationdate><title>Metal or Modularity: Why do Metal Backed Tibias Have Inferior Outcomes to All-Polyethylene Tibial Components in Patients with Osteoarthritis</title><author>Houdek, Matthew T., MD ; Watts, Chad D., MD ; Wyles, Cody C., MD ; Martin, John R., MD ; Trousdale, Robert T., MD ; Taunton, Michael J., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-844bdcd1ba843c24d24e4dba5ccea07999292a810acc216782b3dec69214d5103</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>all-polyethylene tibia</topic><topic>Arthroplasty, Replacement, Knee - instrumentation</topic><topic>Body Mass Index</topic><topic>Cartilage Diseases - surgery</topic><topic>Female</topic><topic>Humans</topic><topic>Knee Prosthesis - statistics & numerical data</topic><topic>Male</topic><topic>metal-backed tibia</topic><topic>Minnesota - epidemiology</topic><topic>modular metal-backed tibia</topic><topic>monoblock metal-backed tibia</topic><topic>Orthopedics</topic><topic>osteoarthritis</topic><topic>Osteoarthritis - surgery</topic><topic>Osteoarthritis, Knee - surgery</topic><topic>outcome</topic><topic>Polyethylene</topic><topic>primary total knee arthroplasty</topic><topic>Prosthesis Design</topic><topic>Prosthesis-Related Infections - epidemiology</topic><topic>Reoperation - statistics & numerical data</topic><topic>Tibia - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Houdek, Matthew T., MD</creatorcontrib><creatorcontrib>Watts, Chad D., MD</creatorcontrib><creatorcontrib>Wyles, Cody C., MD</creatorcontrib><creatorcontrib>Martin, John R., MD</creatorcontrib><creatorcontrib>Trousdale, Robert T., MD</creatorcontrib><creatorcontrib>Taunton, Michael J., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of arthroplasty</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Houdek, Matthew T., MD</au><au>Watts, Chad D., MD</au><au>Wyles, Cody C., MD</au><au>Martin, John R., MD</au><au>Trousdale, Robert T., MD</au><au>Taunton, Michael J., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Metal or Modularity: Why do Metal Backed Tibias Have Inferior Outcomes to All-Polyethylene Tibial Components in Patients with Osteoarthritis</atitle><jtitle>The Journal of arthroplasty</jtitle><addtitle>J Arthroplasty</addtitle><date>2017-03-01</date><risdate>2017</risdate><volume>32</volume><issue>3</issue><spage>836</spage><epage>842</epage><pages>836-842</pages><issn>0883-5403</issn><eissn>1532-8406</eissn><abstract>Background Biomechanical studies have suggested improved stress distribution in metal-backed (MB) compared to all-polyethylene (AP) tibias, but such potential benefits have not been realized clinically. The purpose of this investigation was to analyze the outcomes of AP components in patients with primary osteoarthritis and compare the results to those obtained with MB tibial components in total knee arthroplasty (TKA). Methods We reviewed 11,653 patients undergoing primary TKA for osteoarthritis. There were 9,999 (86%) MB (8,470 modular and 1,529 monoblock) and 1,654 (14%) AP tibial components. All patients had at least 2 years of clinical follow-up with mean follow-up of 8 years (range 2-30 years). Results Mean survivorship for all primary TKA’s at the 5-, 10-, 15-, and 20-year time points was 97%, 92%, 86%, and 78%. AP tibial components were found to have improved survivorship when compared to modular and monoblock MB counterparts (P<0.0001). Likewise, AP tibial components were found to have lower rates of tibial component loosening (P<0.0001), tibial osteolysis, and component fracture. Furthermore, the AP group had improved survival rates in most age groups except <55 years where there was no difference. AP tibial components demonstrated improved survival for all BMI groups except in patients with a BMI ≤25 kg/m2 where there was no difference. Conclusion AP tibial components had significantly improved implant survival across all age groups and most BMI categories in patients who underwent TKA for osteoarthritis. Given these outcomes AP tibias are a reasonable option, regardless of patient age and BMI. Level of Evidence Therapeutic Level III</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27816367</pmid><doi>10.1016/j.arth.2016.09.036</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-7636-0489</orcidid><orcidid>https://orcid.org/0000-0003-0390-1018</orcidid></addata></record> |
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| subjects | Aged all-polyethylene tibia Arthroplasty, Replacement, Knee - instrumentation Body Mass Index Cartilage Diseases - surgery Female Humans Knee Prosthesis - statistics & numerical data Male metal-backed tibia Minnesota - epidemiology modular metal-backed tibia monoblock metal-backed tibia Orthopedics osteoarthritis Osteoarthritis - surgery Osteoarthritis, Knee - surgery outcome Polyethylene primary total knee arthroplasty Prosthesis Design Prosthesis-Related Infections - epidemiology Reoperation - statistics & numerical data Tibia - surgery |
| title | Metal or Modularity: Why do Metal Backed Tibias Have Inferior Outcomes to All-Polyethylene Tibial Components in Patients with Osteoarthritis |
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