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Acta Orthop. 2015;86(6):721-7. doi: 10.3109/17453674.2015.1065046. Epub 2015 Jun 28.

Lower prosthesis-specific 10-year revision rate with crosslinked than with non-crosslinked polyethylene in primary total knee arthroplasty.

Author information

1
a 1 Australian Orthopaedic Association National Joint Replacement Registry, Discipline of Public Health, University of Adelaide , Adelaide.
2
b 2 School of Population Health and Clinical Practice, University of Adelaide , Adelaide, SA, Australia.
3
c 3 Harris Orthopaedic Laboratory, Massachusetts General Hospital , Boston, MA, USA.
4
d 4 Data Management and Analysis Centre, University of Adelaide , Adelaide, SA, Australia.

Abstract

BACKGROUND AND PURPOSE:

While highly crosslinked polyethylene has shown reduced in vivo wear and lower rates of revision for total hip arthroplasty, there have been few long-term studies on its use in total knee arthroplasty (TKA). We compared the rate of revision of non-crosslinked polyethylene to that of crosslinked polyethylene in patients who underwent TKA for osteoarthritis.

PATIENTS AND METHODS:

We examined data from the Australian Orthopaedic Association National Joint Replacement Registry on 302,214 primary TKA procedures with non-crosslinked polyethylene and 83,890 procedures with crosslinked polyethylene, all of which were performed for osteoarthritis. The survivorship of the different polyethylenes was estimated using the Kaplan-Meier method and was compared using proportional hazard models.

RESULTS:

The 10-year cumulative revision rate for non-crosslinked polyethylene was 5.8% (95% CI: 5.7-6.0) and for crosslinked polyethylene it was 3.5% (95% CI: 3.2-3.8) (> 6.5-year HR = 2.2 (1.5-3.1); p < 0.001). There was no effect of surgical volume or method of prosthesis fixation on outcome. There were 4 different TKA designs that had a minimum of 2,500 procedures in at least 1 of the polyethylene groups and a follow-up of ≥ 5 years. 2 of these, the NexGen and the Natural Knee II, had a lower rate of revision for crosslinked polyethylene. The Scorpio NRG/Series 7000 and the Triathlon Knee did not show a lower rate of revision for crosslinked polyethylene.

INTERPRETATION:

There is a lower rate of revision for crosslinked polyethylene in TKA, and this appears to be prosthesis-specific and when it occurs is most evident in patients < 65 years of age. The difference in revision rates was mainly due to revisions because of lysis and loosening.

PMID:
26119884
PMCID:
PMC4750773
DOI:
10.3109/17453674.2015.1065046
[Indexed for MEDLINE]
Free PMC Article

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