Clinical Orthopaedics and Related Research®

, Volume 470, Issue 12, pp 3549–3559

All-polyethylene Tibial Components are Equal to Metal-backed Components: Systematic Review and Meta-regression

  • Klaas Auke Nouta
  • Wiebe C. Verra
  • Bart G. Pijls
  • Jan W. Schoones
  • Rob G. H. H. Nelissen
Survey

DOI: 10.1007/s11999-012-2582-2

Cite this article as:
Nouta, K.A., Verra, W.C., Pijls, B.G. et al. Clin Orthop Relat Res (2012) 470: 3549. doi:10.1007/s11999-012-2582-2

Abstract

Background

Less than 1% of all primary TKAs are performed with an all-polyethylene tibial component, although recent studies indicate all-polyethylene tibial components are equal to or better than metal-backed ones.

Questions/purposes

We asked whether the metal-backed tibial component was clinically superior to the all-polyethylene tibial component in primary TKAs regarding revision rates and clinical functioning, and which modifying variables affected the revision rate.

Methods

We systematically reviewed the literature for clinical studies comparing all-polyethylene and metal-backed tibial components used in primary TKAs in terms of revision rates, clinical scores, and radiologic parameters including radiostereometric analysis (RSA). Meta-regression techniques were used to explore factors modifying the observed effect. Our search yielded 1557 unique references of which 26 articles were included, comprising more than 12,500 TKAs with 231 revisions for any reason.

Results

Meta-analysis showed no differences between the all-polyethylene and metal-backed components except for higher migration of the metal-backed components. Meta-regression showed strong evidence that the all-polyethylene design has improved with time compared with the metal-backed design.

Conclusions

The all-polyethylene components were equivalent to metal-backed components regarding revision rates and clinical scores. The all-polyethylene components had better fixation (RSA) than the metal-backed components. The belief that metal-backed components are better than all-polyethylene ones seems to be based on studies from earlier TKAs. This might no longer be true for modern TKAs.

Level of Evidence

Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Klaas Auke Nouta
    • 1
  • Wiebe C. Verra
    • 1
  • Bart G. Pijls
    • 1
  • Jan W. Schoones
    • 2
  • Rob G. H. H. Nelissen
    • 1
  1. 1.Department of OrthopaedicsLeiden University Medical CenterLeidenThe Netherlands
  2. 2.Walaeus LibraryLeiden University Medical CenterLeidenThe Netherlands