Alternative bearings in total knee arthroplasty: risk of early revision compared to traditional bearings: an analysis of 62,177 primary cases

Maria C S Inacio, Guy Cafri, Elizabeth W Paxton, Steven M Kurtz, Robert S Namba

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BACKGROUND AND PURPOSE: There is no substantial clinical evidence for the superiority of alternative bearings in total knee arthroplasty (TKA). We compared the short-term revision risk in alternative surface bearing knees (oxidized zirconium (OZ) femoral implants or highly crosslinked polyethylene (HXLPE) inserts) with that for traditional bearings (cobalt-chromium (CoCR) on conventional polyethelene (CPE)). The risk of revision with commercially available HXLPE inserts was also evaluated.

METHODS: All 62,177 primary TKA cases registered in a Total Joint Replacement Registry between April 2001 and December 2010 were retrospectively analyzed. The endpoints for the analysis were all-cause revisions, septic revisions, or aseptic revisions. Bearing surfaces were categorized as OZ-CPE, CoCr-HXLPE, or CoCr-CPE. HXLPE inserts were stratified according to brand name. Confounding was addressed using propensity score weights. Marginal Cox-regression models adjusting for surgeon clustering were used.

RESULTS: The proportion of females was 62%. Average age was 68 (SD 9.3) years, and median follow-up time was 2.8 (IQR 1.2-4.9) years. After adjustments, the risks of all-cause, aseptic, and septic revision with CoCr-HXLPE and OZ-CPE bearings were not statistically significantly higher than with traditional CoCr-CPE bearings. No specific brand of HXLPE insert was associated with a higher risk of all-cause, aseptic, or septic revision compared to CoCr-CPE.

INTERPRETATION: At least in the short term, none of the alternative knee bearings evaluated (CoCr-HXLPE or OZ-CPE) had a greater risk of all-cause, aseptic, and septic revision than traditional CoCr-CPE bearings.

Original languageEnglish
Pages (from-to)145-52
Number of pages8
JournalActa Orthopaedica
Issue number2
Publication statusPublished or Issued - Apr 2013
Externally publishedYes


  • Aged
  • Arthroplasty, Replacement, Knee
  • Chromium Alloys
  • Female
  • Follow-Up Studies
  • Humans
  • Knee Prosthesis
  • Male
  • Middle Aged
  • Polyethylene
  • Prosthesis Design
  • Prosthesis Failure
  • Reoperation
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Zirconium
  • Comparative Study
  • Journal Article
  • Research Support, Non-U.S. Gov't

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