Despite Improved Survivorship of Uncemented Fixation in Total Knee Arthroplasty for Osteoarthritis, Cemented Fixation Remains the Gold Standard: An Analysis of a National Joint Registry

AbstractAll-polyethylene tibial (APT) implants were incorporated into the initial design of the first total knee arthroplasty (TKA) systems. Since then, a dynamic shift has taken place and metal-backed tibial (MBT) implants have become the gold standard in TKA. This has mostly been due to the theoretical advantages of intraoperative flexibility and improved biomechanics in addition to the heavy influence of device manufacturers. MBT implant comes not only with a higher cost but also with potential for complications such as osteolysis, backside wear, and thinning of the polyethylene insert, which were not previously seen with APT implant. The majority of studies comparing APT and MBT implants have shown no difference in clinical outcomes and survivorship. Newer studies from the past decade have begun highlighting the economic advantages of APT implant, especially in patients undergoing primary, uncomplicated TKA. Use of APT implants in younger patients and those with a body mass index > 35 has not been extensively studied, but the existing literature suggests the use of APT implant in these cohorts to be equally as acceptable. With modern implant design and instrumentation, rising utilization of TKA along with current and future economic strain on health care, the increased use of APT implant could result in massive savings without sacrificing positive patient outcomes.

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Is “symmetric” gap balancing still the gold standard in primary total knee arthroplasty?

Annals of Translational Medicine ◽

10.21037/atm.2017.06.18 ◽

2017 ◽

Vol 5 (16) ◽

pp. 325-325 ◽

Cited By ~ 7

Author(s):

Salvatore Risitano ◽

Pier Francesco Indelli

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Gold Standard ◽

Primary Total Knee Arthroplasty ◽

Gap Balancing ◽

Total Knee ◽

Primary Total Knee

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Hip and knee arthroplasty implants contraindicated in obesity

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0103 ◽

2016 ◽

Vol 98 (5) ◽

pp. 295-299 ◽

Cited By ~ 9

Author(s):

JD Craik ◽

MD Bircher ◽

M Rickman

Keyword(s):

Knee Arthroplasty ◽

Obese Patients ◽

National Joint Registry ◽

Surgical Practice ◽

Joint Registry ◽

Hip And Knee Arthroplasty ◽

Total Knee ◽

The Mean ◽

Product Literature ◽

Primary Total Hip Arthroplasty

IntroductionHigh patient weight is a risk factor for mechanical implant failure and some manufacturers list obesity as a contraindication for implant use. We reviewed data from the 2012–2013 UK National Joint Registry to determine whether surgical practice reflects these manufacturer recommendations.MethodsThe product literature for the most commonly used hip and knee implants was reviewed for recommendations against use in obese patients (body mass index [BMI] ≥ 30kg/m2). The total number of obese patients undergoing hip and knee arthroplasty was calculated, as was the proportion receiving implants against manufacturer recommendations.ResultsOut of 200,054 patient records, 147,691 (74%) had a recorded BMI. The mean BMI for patients undergoing primary total hip arthroplasty was 29kg/m2, compared with 31kg/m2for total knee arthroplasty. Of the 25 components reviewed, 5 listed obesity as a contraindication or recommended against implant use in obese patients. A total of 10,745 patients (16% of all obese patients) received implants against manufacturer recommendations.ConclusionsA high proportion of patients are receiving implants against manufacturer recommendations. However, there are limitations to using BMI for stratifying risk of implant fatigue failure and manufacturers should therefore provide more detailed guidelines on size specific implant load limits to facilitate surgical decisions.

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