J Knee Surg 2015; 28(05): 382-389
DOI: 10.1055/s-0035-1551832
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Role of All-Polyethylene Tibial Components in Modern TKA

James Doran
1   Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, New York
,
Stephen Yu
1   Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, New York
,
Daniel Smith
1   Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, New York
,
Richard Iorio
1   Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, New York
› Author Affiliations
Further Information

Publication History

26 February 2015

11 March 2015

Publication Date:
18 June 2015 (online)

Abstract

In the modern era of total knee arthroplasty (TKA), a majority of orthopedic surgeons utilize metal-backed tibial (MBT) components rather than nonmodular designs, such as all-polyethylene tibial (APT) components. Interestingly, current clinical evidence does not explain this disproportionate practice by surgeons. The shift in surgeon preference from APT to MBT components occurred in the 1980s following unfavorable results from early studies with APT. However, results from current studies that have revisited the APT versus MBT component comparison demonstrate similar implant survivorship and patient outcomes. Despite equivalent survivorship and improved cost-efficiency, APT components have not achieved equivalent utilization rates with MBT. This review of the current literature, as well as the advantages and disadvantages of APT components, will outline a rationale for the role of APT components in today's cost-driven, outcomes-oriented, patient-centered health-care system.

 
  • 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 (4) 780-785
  • 2 Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 2004; 86-A (5) 963-974
  • 3 Bozic KJ, Morshed S, Silverstein MD, Rubash HE, Kahn JG. Use of cost-effectiveness analysis to evaluate new technologies in orthopaedics. The case of alternative bearing surfaces in total hip arthroplasty. J Bone Joint Surg Am 2006; 88 (4) 706-714
  • 4 Mendenhall S. The 2011 U.S. knee implant price comparison. Orthopedic Network News 2011; 22 (3) 18
  • 5 Kurtz SM, Gawel HA, Patel JD, Jasmine D, Patel JD. History and systematic review of wear and osteolysis outcomes for first-generation highly crosslinked polyethylene. Clin Orthop Relat Res 2011; 469 (8) 2262-2277
  • 6 Kurtz SM. Chapter 7: The origins and adaptations of UHMWPE for knee replacements. In: Kurtz SM, ed. The UHMWPE Handbook. San Diego, CA: Academic Press; 2004: 123-150
  • 7 Brach Del Prever EM, Bistolfi A, Bracco P, Costa L. UHMWPE for arthroplasty: past or future?. J Orthop Traumatol 2009; 10 (1) 1-8
  • 8 Evanski PM, Waugh TR, Orofino CF, Anzel SH. UCI knee replacement. Clin Orthop Relat Res 1976; 120: 33-38
  • 9 Ducheyne P, Kagan II A, Lacey JA. Failure of total knee arthroplasty due to loosening and deformation of the tibial component. J Bone Joint Surg Am 1978; 60 (3) 384-391
  • 10 Insall J, Scott WN, Ranawat CS. The total condylar knee prosthesis. A report of two hundred and twenty cases. J Bone Joint Surg Am 1979; 61 (2) 173-180
  • 11 Dorr LD, Coanty JP, Shriber R. Technical factors that influence mechanical loosening of total knee arthroplasty. In: Dorr LD, ed. The Knee Papers of the First Scientific Meeting of the Knee Society. 3rd ed. Baltimore, MD: University Park Press; 1985: 121
  • 12 Hamilton LR. UCI total knee replacement. A follow-up study. J Bone Joint Surg Am 1982; 64 (5) 740-744
  • 13 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-A (3) 489-493
  • 14 Reilly D, Walker PS, Ben-Dov M, Ewald FC. Effects of tibial components on load transfer in the upper tibia. Clin Orthop Relat Res 1982; 165: 273-282
  • 15 Walker PS, Ranawat C, Insall J. Fixation of the tibial components of condylar replacement knee prostheses. J Biomech 1976; 9 (4) 269-275
  • 16 Walker PS, Greene D, Reilly D, Thatcher J, Ben-Dov M, Ewald FC. Fixation of tibial components of knee prostheses. J Bone Joint Surg Am 1981; 63 (2) 258-267
  • 17 Gioe TJ, Maheshwari AV. The all-polyethylene tibial component in primary total knee arthroplasty. J Bone Joint Surg Am 2010; 92 (2) 478-487
  • 18 Bartel DL, Burstein AH, Santavicca EA, Insall JN. Performance of the tibial component in total knee replacement. J Bone Joint Surg Am 1982; 64 (7) 1026-1033
  • 19 Bartel DL, Bicknell VL, Wright TM. The effect of conformity, thickness, and material on stresses in ultra-high molecular weight components for total joint replacement. J Bone Joint Surg Am 1986; 68 (7) 1041-1051
  • 20 Murase K, Crowninshield RD, Pedersen DR, Chang TS. An analysis of tibial component design in total knee arthroplasty. J Biomech 1983; 16 (1) 13-22
  • 21 Small SR, Berend ME, Ritter MA, Buckley CA. A comparison in proximal tibial strain between metal-backed and all-polyethylene anatomic graduated component total knee arthroplasty tibial components. J Arthroplasty 2010; 25 (5) 820-825
  • 22 Taylor M, Tanner KE. Fatigue failure of cancellous bone: a possible cause of implant migration and loosening. J Bone Joint Surg Br 1997; 79 (2) 181-182
  • 23 Yoshino K, Koga Y, Segawa H , et al. Properties of the tibial component regarding impact load. Clin Orthop Relat Res 2004; 423: 172-177
  • 24 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 (6) 769-777
  • 25 Norgren B, Dalén T, Nilsson KG. All-poly tibial component better than metal-backed: a randomized RSA study. Knee 2004; 11 (3) 189-196
  • 26 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
  • 27 L'Insalata JL, Stern SH, Insall JN. Total knee arthroplasty in elderly patients. Comparison of tibial component designs. J Arthroplasty 1992; 7 (3) 261-266
  • 28 Pomeroy DL, Schaper LA, Badenhausen WE , et al. Results of all-polyethylene tibial components as a cost-saving technique. Clin Orthop Relat Res 2000; 380: 140-143
  • 29 Pagnano MW, Levy BA, Berry DJ. Cemented all polyethylene tibial components in patients age 75 years and older. Clin Orthop Relat Res 1999; 367: 73-80
  • 30 van der Ven A, Scott RD, Barnes CL. All-polyethylene tibial components in octogenarians: survivorship, performance, and cost. Am J Orthop 2014; 43 (1) 21-24
  • 31 Muller SD, Deehan DJ, Holland JP , et al. Should we reconsider all-polyethylene tibial implants in total knee replacement?. J Bone Joint Surg Br 2006; 88 (12) 1596-1602
  • 32 Healy WL, Rana AJ, Iorio R. Hospital economics of primary total knee arthroplasty at a teaching hospital. Clin Orthop Relat Res 2011; 469 (1) 87-94
  • 33 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 03): 7-11
  • 34 Toman J, Iorio R, Healy WL. All-polyethylene and metal-backed tibial components are equivalent with BMI of less than 37.5. Clin Orthop Relat Res 2012; 470 (1) 108-116
  • 35 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 (1) 117-124
  • 36 Luna JT, Sembrano JN, Gioe TJ. Mobile and fixed-bearing (all-polyethylene tibial component) total knee arthroplasty designs: surgical technique. J Bone Joint Surg Am 2010; 92 (Suppl 1 Pt 2) 240-249
  • 37 Martin S, Saurez A, Ismaily S, Ashfaq K, Noble P, Incavo SJ. Maximizing tibial coverage is detrimental to proper rotational alignment. Clin Orthop Relat Res 2014; 472 (1) 121-125
  • 38 Parks NL, Engh GA, Topoleski LD, Emperado J. The Coventry Award. Modular tibial insert micromotion. A concern with contemporary knee implants. Clin Orthop Relat Res 1998; 356: 10-15
  • 39 Rao AR, Engh GA, Collier MB, Lounici S. Tibial interface wear in retrieved total knee components and correlations with modular insert motion. J Bone Joint Surg Am 2002; 84-A (10) 1849-1855
  • 40 Jayabalan P, Furman BD, Cottrell JM, Wright TM. Backside wear in modern total knee designs. HSS J 2007; 3 (1) 30-34
  • 41 Holleyman RJ, Scholes SC, Weir D , et al. Changes in surface topography at the TKA backside articulation following in vivo service: a retrieval analysis. Knee Surg Sports Traumatol Arthrosc 2014;
  • 42 Griffin WL, Scott RD, Dalury DF, Mahoney OM, Chiavetta JB, Odum SM. Modular insert exchange in knee arthroplasty for treatment of wear and osteolysis. Clin Orthop Relat Res 2007; 464: 132-137
  • 43 Willson SE, Munro ML, Sandwell JC, Ezzet KA, Colwell Jr CW. Isolated tibial polyethylene insert exchange outcomes after total knee arthroplasty. Clin Orthop Relat Res 2010; 468 (1) 96-101
  • 44 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 (7) 1587-1594
  • 45 Bettinson KA, Pinder IM, Moran CG, McCaskie AW, Lingard EA. A randomized controlled trial of all-polyethylene versus metal-backed tibial component: 5–8 year results. Presented at: Annual Meeting of the American Academy of Orthopaedic Surgeons; Feb 5–9, 2003; New Orleans, LA.
  • 46 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 (8) 1438-1449
  • 47 Kalisvaart MM, Pagnano MW, Trousdale RT, Stuart MJ, Hanssen AD. Randomized clinical trial of rotating-platform and fixed-bearing total knee arthroplasty: no clinically detectable differences at five years. J Bone Joint Surg Am 2012; 94 (6) 481-489
  • 48 Nouta KA, Verra WC, Pijls BG, Schoones JW, Nelissen RG. All-polyethylene tibial components are equal to metal-backed components: systematic review and meta-regression. Clin Orthop Relat Res 2012; 470 (12) 3549-3559
  • 49 Mohan V, Inacio MC, Namba RS, Sheth D, Paxton EW. Monoblock all-polyethylene tibial components have a lower risk of early revision than metal-backed modular components. A registry study of 27,657 primary total knee arthroplasties. Acta Orthop 2013; 84 (6) 530-536
  • 50 Gudnason A, Hailer NP, W-Dahl A, Sundberg M, Robertsson O. 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
  • 51 Healy WL, Iorio R, Ko J, Appleby D, Lemos DW. Impact of cost reduction programs on short-term patient outcome and hospital cost of total knee arthroplasty. J Bone Joint Surg Am 2002; 84-A (3) 348-353
  • 52 Gioe TJ, Sinner P, Mehle S, Ma W, Killeen KK. Excellent survival of all-polyethylene tibial components in a community joint registry. Clin Orthop Relat Res 2007; 464 (464) 88-92
  • 53 Gioe TJ, Glynn J, Sembrano J, Suthers K, Santos ERG, Singh J. Mobile and fixed-bearing (all-polyethylene tibial component) total knee arthroplasty designs. A prospective randomized trial. J Bone Joint Surg Am 2009; 91 (9) 2104-2112
  • 54 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