Abstract
Introduction
While considered a satisfactory solution, unicompartmental knee arthroplasty (UKA) still raises concerns in regard to its durability. These concerns particularly focus on the tibial component. This study aims to compare two different cemented tibial components belonging to the same UKA design: all polyethylene (AP) versus metal backed (MB), at a long-term follow-up.
Materials and methods
We retrospectively reviewed 143 successive patients, 83 of which underwent surgery with AP tibial component UKA (37 males, 46 females), and 67 with MB ones (17 males, 50 females). All implants had the same prosthetic design (Accuris UKA, Smith e Nephew) with identical femoral oxinium component but different tibial component, AP or MB. The KSS and KOOS were assessed at a mean of 11.5-year follow-up and compared to pre-operative, post-operative, and one year evaluation. Statistical analysis was performed with SPSS for Mac (version 17.0). To assess potential statistically significant differences, t test was used and significance was set at P < 0.05.
Results
Final KSS at a mean of 11.5-year follow-up was 94.27 for the AP group and 96.12 for the MB ones. The final KOOS was 87 for AP components and 89.67 for the MB group. These results demonstrated, in all cases, statistically significant better results for MB tibial components compared to AP regarding KSS (P = 0.048), KOOS (P = 0.000), and pain (P = 0.014) at the 11.5-year follow-up. Survivorship for AP tibial component implants was 97.6%, while it was 89.5% for MB ones.
Conclusion
While the survivorship rate has been found to be greater for AP implants compared to MB tibial components, this study reveals statistically better functional results according to KSS and KOOS, and pain, at a long-term follow-up for MB implants.
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References
Niinimäki T, Eskelinen A, Mäkelä K, Ohtonen P, Puhto AP, Remes V (2014) Unicompartmental knee arthroplasty survivorship is lower than TKA survivorship: a 27-year Finnish registry study. Clin Orthop Relat Res 472(5):1496–1501. https://doi.org/10.1007/s11999-013-3347-2
Liddle AD, Pandit H, Judge A, Murray DW (2015) Optimal usage of unicompartmental knee arthroplasty: a study of 41,986 cases from the National Joint Registry for England and Wales. Bone Joint J 97-B(11):1506–1511. https://doi.org/10.1302/0301-620X.97B11.35551
Saenz CL, McGrath MS, Marker DR, Seyler TM, Mont MA, Bonutti PM (2010) Early failure of a unicompartmental knee arthroplasty design with an all-polyethylene tibial component. Knee 17(1):53. https://doi.org/10.1016/j.knee.2009.05.007
Hutt JR, Farhadnia P, Masse V, LaVigne M, Vendittoli PA (2015) A randomised trial of all-polyethylene and metal-backed tibial components in unicompartmental arthroplasty of the knee. Bone Joint J 97-B:786–792. https://doi.org/10.1302/0301-620X.97B6.35433
Koh IJ, Suhl KH, Kim MW, Kim MS, Choi KY, In Y (2017) Use of all-polyethylene tibial components in unicompartmental knee arthroplasty increases the risk of early failure. J Knee Surg 30(8):807. https://doi.org/10.1055/s-0036-1597979
Small SR, Berend ME, Ritter MA, Buckley CA, Rogge RD (2011) Metal backing significantly decreases tibial strains in a medial unicompartmental knee arthroplasty model. J Arthroplast 26:777–782. https://doi.org/10.1016/j.arth.2010.07.021
Scott CE, Eaton MJ, Nutton RW, Wade FA, Pankaj P, Evans SL (2013) Proximal tibial strain in medial unicompartmental knee replacements: a biomechanical study of implant design. Bone Joint J 95-B:1339–1347. https://doi.org/10.1302/0301-620X.95B10.31644
Kumar V, Hasan O, Umer M, Baloch N (2019) Cemented all-poly tibia in resource constrained country, affordable and cost-effective care. Is it applicable at this era? Review article. Ann Med Surg (Lond) 47:36–40. Published 2019 Sep 27. https://doi.org/10.1016/j.amsu.2019.09.010
Voigt J, Mosier M (2011) Cemented all-polyethylene and metal-backed polyethylene tibial components used for primary total knee arthroplasty: a systematic review of the literature and meta-analysis of randomized controlled trials involving 1798 primary total knee implants. J Bone Joint Surg Am 93(19):1790–1798. https://doi.org/10.2106/JBJS.J.01303
Newman J, Pydisetty RV, Ackroyd C (2009) Unicompartmental or total knee replacement: the 15-year results of a prospective randomised controlled trial. J Bone Joint Surg (Br) 91:52–57. https://doi.org/10.1302/0301-620X.91B1.20899
Forster-Horvath C, Artz N, Hassaballa MA, Robinson JR, Porteous AJ, Murray JR, Newman JH (2016) Survivorship and clinical outcome of the minimally invasive Uniglide medial fixed bearing, all-polyethylene tibia, unicompartmental knee arthroplasty at a mean follow-up of 7.3 years. Knee 23(6):981. https://doi.org/10.1016/j.knee.2016.07.003
Bruni D, Gagliardi M, Akkawi I, Raspugli GF, Bignozzi S, Marko T, Bragonzoni L, Grassi A, Marcacci M (2016) Good survivorship of all-polyethylene tibial component UKA at long-term follow-up. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 24(1):182. https://doi.org/10.1007/s00167-014-3361-2
Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH, Scott WN (2012) The new knee society knee scoring system. Clin Orthop Relat Res 470(1):3–19. https://doi.org/10.1007/s11999-011-2135-0
Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998 Aug) Knee Injury and Osteoarthritis Outcome Score (KOOS)-development of a self-administered outcome measure. J Orthop Sports Phys Ther 28(2):88–96. https://doi.org/10.2519/jospt.1998.28.2.88
Nouta KA, Verra WC, Pijls BG, Schoones JW, Nelissen RG (2012) All-polyethylene tibial components are equal to metal-backed components: systematic review and meta-regression. Clin Orthop Relat Res 470(12):3549–3559. https://doi.org/10.1007/s11999-012-2582-2
Gioe TJ, Sinner P, Mehle S, Ma W, Killeen KK (2007) Excellent survival of all-polyethylene tibial components in a community joint registry. Clin Orthop Relat Res 464:88–92. https://doi.org/10.1097/BLO.0b013e31812f7879
Bettinson KA, Pinder IM, Moran CG, Weir DJ, Lingard EA (2009) All-polyethylene compared with metal-backed tibial components in total knee arthroplasty at ten years. A prospective, randomized controlled trial. J Bone Joint Surg Am 91(7):1587–1594. https://doi.org/10.2106/JBJS.G.01427
Longo UG, Ciuffreda M, D’Andrea V, Mannering N, Locher J, Denaro V (2017) All-polyethylene versus metal-backed tibial component in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25(11):3620–3636. https://doi.org/10.1007/s00167-016-4168-0
Mohan V, Inacio MC, Namba RS, Sheth D, Paxton EW (2013) Monoblock all-polyethylene tibial components have a lower risk of early revision than metal-backed modular components. Acta Orthop 84(6):530–536. https://doi.org/10.3109/17453674.2013.862459
Rouanet T, Combes A, Migaud H, Pasquier G (2013) Do bone loss and reconstruction procedures differ at revision of cemented unicompartmental knee prostheses according to the use of metal-back or all-polyethylene tibial component? Orthop Traumatol Surg Res 99(6):687–692. https://doi.org/10.1016/j.otsr.2013.03.018
Scott CEH, Wade FA, MacDonald D, Nutton RW (2018) Ten-year survival and patient-reported outcomes of a medial unicompartmental knee arthroplasty incorporating an all-polyethylene tibial component. Arch Orthop Trauma Surg 138(5):719–729. https://doi.org/10.1007/s00402-018-2908-y
Simpson DJ, Price AJ, Gulati A, Murray DW, Gill HS (2009) Elevated proximal tibial strains following unicompartmental knee replacement—a possible cause of pain. Med Eng Phys 31:752–757. https://doi.org/10.1016/j.medengphy.2009.02.004
van der List JP, Kleeblad LJ, Zuiderbaan HA, Pearle AD (2017) Mid-term outcomes of metal-backed unicompartmental knee arthroplasty show superiority to all-polyethylene unicompartmental and total knee arthroplasty. HSS J 13(3):232–240. https://doi.org/10.1007/s11420-017-9557-5
Costa GG, Lo Presti M, Grassi A, Agrò G, Cialdella S, Mosca M, Caravelli S, Zaffagnini S (2020) Metal-backed tibial components do not reduce risk of early aseptic loosening in unicompartmental knee arthroplasty: a systematic review and meta-analysis. J Knee Surg 33(2):180–189. https://doi.org/10.1055/s-0038-1677506
Lustig S, Paillot JL, Servien E, Henry J, Ait Si Selmi T, Neyret P (2009) Cemented all polyethylene tibial insert unicompartmental knee arthroplasty: a long term follow-up study. Orthop Traumatol Surg Res 95:12–21. https://doi.org/10.1016/j.otsr.2008.04.001
Manzotti A, Confalonieri N, Pullen C (2007) Unicompartmental versus computer-assisted total knee replacement for medial compartment knee arthritis: a matched paired study. Int Orthop 31:315–319. https://doi.org/10.1007/s00264-006-0184-x
Sessa V, Paciotti M, Celentano U, Papalia R. Two peg versus flat tibial tray design in unicompartmental knee arthroplasty. Oral presentation 19° EFORT Congress, Barcelona 30 may - 01 june, 2018
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This retrospective cohort study was conducted at S. Giovanni Calibita Hospital of Rome in accordance with the ethical standards of the institutional and national research committee, the 1964 Declaration of Helsinki, and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. Patients were informed and gave consent regarding the use of their data for publication purposes.
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Sessa, V., Celentano, U. Unicompartmental knee arthroplasty: all-poly versus metal-backed tibial component—a long-term follow-up study. International Orthopaedics (SICOT) 45, 3063–3068 (2021). https://doi.org/10.1007/s00264-021-05031-3
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DOI: https://doi.org/10.1007/s00264-021-05031-3