TY - JOUR
T1 - Is There a Difference in Total Knee Arthroplasty Risk of Revision in Highly Crosslinked versus Conventional Polyethylene?
AU - Paxton, Elizabeth W.
AU - Inacio, Maria C.S.
AU - Kurtz, Steven
AU - Love, Rebecca
AU - Cafri, Guy
AU - Namba, Robert S.
N1 - Publisher Copyright:
© 2015, The Association of Bone and Joint Surgeons®.
PY - 2015/2/5
Y1 - 2015/2/5
N2 - Methods: The Kaiser Permanente Total Joint Replacement Registry was used to identify primary TKAs (N = 77,084) performed during the study period (April 2001 to December 2011) with cobalt-chromium alloy on CPE (CoCr-CPE) and CoCr-HXLPE bearings. The registry has 95% voluntary participation and less than 9% were loss to followup during the 10-year study period. A total of 60,841 (79%) had CoCr-CPE bearings, 11,048 (14%) had CoCr-HXLPE bearings, and 5195 (7%) were unknown. Specific knee implant designs (NexGen, Zimmer and PFC-Sigma, DePuy Inc) were also evaluated. These implants represented 41% (31,793) and 49% (37,457), respectively, of the 77,084 TKAs of known implant types registered during that period; implant selection was at the discretion of the attending surgeon. Descriptive statistics and marginal Cox regression models with propensity score adjustments were applied to compare risk of revision for CoCr-CPE versus CoCr-HXLPE TKA bearings.Results: At 5 years followup, cumulative incidence of revision for CoCr-CPE and CoCr-XLPE were 2.7% and 3.1%, respectively. Adjusted risks of all-cause (hazard ratio [HR], 1.05; 95% confidence interval [CI], 0.86–1.29; p = 0.620), aseptic (HR, 1.01; 95% CI, 0.77–1.32; p = 0.954), and septic revision (HR, 1.11; 95% CI, 0.81–1.51; p = 0.519) did not differ in patients with CoCr-XLPE bearings compared with CoCr-CPE. Within TKAs with NexGen components, the adjusted risks of all-cause (HR, 1.14; 95% CI, 0.86–1.51; p = 0.354), aseptic (HR, 1.14; 95% CI, 0.79–1.65; p = 0.493), and septic revision (HR, 1.14; 95% CI, 0.76–1.73; p = 518) were similar in patients with CoCr-XLPE compared with those with CoCr-CPE bearings. Finally, within the TKAs with PFC components, the adjusted risks of all-cause (HR, 0.80; 95% CI, 0.49–1.30; p = 0.369), aseptic (HR, 0.62; 95% CI, 0.62–1.14; p = 0.123), and septic revision (HR, 0.97; 95% CI, 0.51–1.85; p = 0.929) were also similar in patients with CoCr-XLPE compared with those with CoCr-CPE bearings.Conclusions: In this large study, we did not find differences in risk of revision for CoCr-HXLPE compared with CoCr-CPE bearings at 5 years followup. In selecting HXLPE in TKA, clinicians should consider the increased cost and lack of available evidence of performance for greater than 10 years followup. Future studies are necessary to evaluate longitudinal outcomes of CoCr-HXLPE versus conventional TKA bearings.Level of Evidence: Level III, therapeutic study.Questions/purposes:Background: Highly crosslinked polyethylene (HXLPE) was introduced to reduce wear and associated osteolysis in total knee arthroplasty (TKA). However, there is limited clinical evidence that HXLPE is more effective than conventional polyethylene (CPE) in TKA.
AB - Methods: The Kaiser Permanente Total Joint Replacement Registry was used to identify primary TKAs (N = 77,084) performed during the study period (April 2001 to December 2011) with cobalt-chromium alloy on CPE (CoCr-CPE) and CoCr-HXLPE bearings. The registry has 95% voluntary participation and less than 9% were loss to followup during the 10-year study period. A total of 60,841 (79%) had CoCr-CPE bearings, 11,048 (14%) had CoCr-HXLPE bearings, and 5195 (7%) were unknown. Specific knee implant designs (NexGen, Zimmer and PFC-Sigma, DePuy Inc) were also evaluated. These implants represented 41% (31,793) and 49% (37,457), respectively, of the 77,084 TKAs of known implant types registered during that period; implant selection was at the discretion of the attending surgeon. Descriptive statistics and marginal Cox regression models with propensity score adjustments were applied to compare risk of revision for CoCr-CPE versus CoCr-HXLPE TKA bearings.Results: At 5 years followup, cumulative incidence of revision for CoCr-CPE and CoCr-XLPE were 2.7% and 3.1%, respectively. Adjusted risks of all-cause (hazard ratio [HR], 1.05; 95% confidence interval [CI], 0.86–1.29; p = 0.620), aseptic (HR, 1.01; 95% CI, 0.77–1.32; p = 0.954), and septic revision (HR, 1.11; 95% CI, 0.81–1.51; p = 0.519) did not differ in patients with CoCr-XLPE bearings compared with CoCr-CPE. Within TKAs with NexGen components, the adjusted risks of all-cause (HR, 1.14; 95% CI, 0.86–1.51; p = 0.354), aseptic (HR, 1.14; 95% CI, 0.79–1.65; p = 0.493), and septic revision (HR, 1.14; 95% CI, 0.76–1.73; p = 518) were similar in patients with CoCr-XLPE compared with those with CoCr-CPE bearings. Finally, within the TKAs with PFC components, the adjusted risks of all-cause (HR, 0.80; 95% CI, 0.49–1.30; p = 0.369), aseptic (HR, 0.62; 95% CI, 0.62–1.14; p = 0.123), and septic revision (HR, 0.97; 95% CI, 0.51–1.85; p = 0.929) were also similar in patients with CoCr-XLPE compared with those with CoCr-CPE bearings.Conclusions: In this large study, we did not find differences in risk of revision for CoCr-HXLPE compared with CoCr-CPE bearings at 5 years followup. In selecting HXLPE in TKA, clinicians should consider the increased cost and lack of available evidence of performance for greater than 10 years followup. Future studies are necessary to evaluate longitudinal outcomes of CoCr-HXLPE versus conventional TKA bearings.Level of Evidence: Level III, therapeutic study.Questions/purposes:Background: Highly crosslinked polyethylene (HXLPE) was introduced to reduce wear and associated osteolysis in total knee arthroplasty (TKA). However, there is limited clinical evidence that HXLPE is more effective than conventional polyethylene (CPE) in TKA.
UR - http://www.scopus.com/inward/record.url?scp=84925493375&partnerID=8YFLogxK
U2 - 10.1007/s11999-014-4046-3
DO - 10.1007/s11999-014-4046-3
M3 - Article
C2 - 25567357
AN - SCOPUS:84925493375
SN - 0009-921X
VL - 473
SP - 999
EP - 1008
JO - Clinical orthopaedics and related research
JF - Clinical orthopaedics and related research
IS - 3
ER -