Clinical Orthopaedics and Related Research®

, Volume 470, Issue 1, pp 108–116 | Cite as

All-polyethylene and Metal-backed Tibial Components Are Equivalent With BMI of Less Than 37.5

Symposium: Papers Presented at the Annual Meetings of the Knee Society



Modular, metal-backed tibial (MBT) components are associated with locking mechanism dysfunction, breakage, backside wear, and osteolysis, which compromise survivorship. All-polyethylene tibial (APT) components eliminate problems associated with MBTs, but, historically, APT utilization has generally been limited to older, less active patients. However, it is unclear whether APT utilization can be expanded to a nonselected patient population.


We therefore determined the survivorship of APT components compared with MBT components in a non-age- or activity-selected population who underwent TKA.


Using a longitudinal database, we identified 775 patients with primary TKAs utilizing a single implant design between 1999 and 2007. Of these, 558 (72%) patients had APT components (APT2), while 217 (28%) patients with tibial bone loss or defects, contralateral MBT components, or a BMI of greater than 37.5 received MBT components. We determined the survivorship in the two groups. The minimum followup was 2 years for both groups (mean ± SD: MBT, 80 ± 29 months; APT, 63 ± 27 months). The APT group was older (average age: APT2, 70 years; MBT, 64.7 years) and had a lower BMI than the MBT group (APT2, 30.8; MBT, 33.8).


Survivorship, as defined by revision for any reason, was 99% for the APT group and 97% for the MBT group. There were four (2%) tibial failures in the MBT group in patients with a BMI of greater than 40. There were no revisions for loosening or osteolysis in the APT group.


APT implants perform as well as MBT implants in a non-age- or activity-selected TKA population with a BMI of less than 37.5.

Level of Evidence

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



The authors thank John Garfi for his editorial and statistical contribution.


  1. 1.
    Apel DM, Tozzi JM, Dorr LD. Clinical comparison of all-polyethylene and metal-backed tibial components in total knee arthroplasty. Clin Orthop Relat Res. 1991;273:243–251.PubMedGoogle Scholar
  2. 2.
    Bargren JH, Blaha JD, Freeman MA. Alignment in total knee arthroplasty: correlated biomechanical and clinical observations. Clin Orthop Relat Res. 1983;173:178–183.PubMedGoogle Scholar
  3. 3.
    Bettinson KA, Pinder IM, Moran CG, Weir DJ, Lingard EA. 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. 2009;91:1587–1594.PubMedCrossRefGoogle Scholar
  4. 4.
    Currier BH, Currier JH, Collier JP, Mayor MB. Effect of fabrication method and resin type on performance of tibial bearings. J Biomed Mater Res. 2000;53:143–151.PubMedCrossRefGoogle Scholar
  5. 5.
    Dalury DF, Pomeroy DL, Gonzales RA, Gruen TA, Adams MJ, Empson JA. Midterm results of all-polyethylene tibial components in primary total knee arthroplasty. J Arthroplasty. 2009;24:620–624.PubMedCrossRefGoogle Scholar
  6. 6.
    Dorr LD, Coanty JP, Shriber R. Technical factors that influence mechanical loosening of total knee arthroplasty. In: Dorr LD, ed. The Knee Papers of the First Scientific Meeting of The Knee Society. 3rd ed. Baltimore, MD: University Park Press; 1985:121.Google Scholar
  7. 7.
    Ducheyne P, Kagan A 2nd, Lacey JA. Failure of total knee arthroplasty due to loosening and deformation of the tibial component. J Bone Joint Surg Am. 1978;60:384–391.PubMedGoogle Scholar
  8. 8.
    Engh GA, Lounici S, Rao AR, Collier MB. In vivo deterioration of tibial baseplate locking mechanisms in contemporary modular total knee components. J Bone Joint Surg Am. 2001;83:1660–1665.PubMedGoogle Scholar
  9. 9.
    Evanski PM, Waugh TR, Orofino CF, Anzel SH. UCI knee replacement. Clin Orthop Relat Res. 1976;120:33–38.PubMedGoogle Scholar
  10. 10.
    Faris PM, Ritter MA, Keating EM, Meding JB, Harty LD. The AGC all-polyethylene tibial component: a ten-year clinical evaluation. J Bone Joint Surg Am. 2003;85:489–493.PubMedGoogle Scholar
  11. 11.
    Font-Rodriguez DE, Scuderi GR, Insall JN. Survivorship of cemented total knee arthroplasty. Clin Orthop Relat Res. 1997;345:79–86.PubMedCrossRefGoogle Scholar
  12. 12.
    Freeman MA, Samuelson KM, Levack B, de Alencar PG. Knee arthroplasty at the London Hospital. Clin Orthop Relat Res. 1986;205:12–20.PubMedGoogle Scholar
  13. 13.
    Gioe TJ, Santos ER, Stroemer ES. All polyethylene and metal-backed tibias have similar outcomes at 10 years: a randomized, level 1 evidence study. Clin Orthop Relat Res. 2007;455:212–218.PubMedCrossRefGoogle Scholar
  14. 14.
    Gioe TJ, Sinner P, Mehle S, Ma W, Killeen KK. Excellent survival of all-polyethylene tibial components in a community joint registry. Clin Orthop Relat Res. 2007;464:88–92.PubMedGoogle Scholar
  15. 15.
    Healy WL, Iorio R, Ko J, Appleby D, Lemos DW. Impact of cost reduction programs on short-term patient outcome and hospital cost of total knee arthroplasty. J Bone Joint Surg Am. 2002;84:348–353.PubMedGoogle Scholar
  16. 16.
    Healy WL, Iorio R, Lemos MJ, Patch D, Pfeifer BA, Smiley PM, Wilk RM. Single price/case price purchasing in orthopedic surgery: experience at the Lahey Clinic. J Bone Joint Surg Am. 2000;82:607–612.PubMedGoogle Scholar
  17. 17.
    Hirakawa K, Bauer TW, Yamaguchi M, Stulberg BN, Wilde AH. Relationship between wear debris particles and polyethylene surface damage in primary total knee arthroplasty. J Arthroplasty. 1999;14:165–171.PubMedCrossRefGoogle Scholar
  18. 18.
    Insall J, Scott WN, Ranawat CS. The total condylar knee prosthesis: a report of two hundred and twenty cases. J Bone Joint Surg Am. 1979;61:173–180.PubMedGoogle Scholar
  19. 19.
    Iorio R, Healy WL, Kirven FM, Pfeifer B, Appleby DA. Knee implant standardization: an implant selection and cost reduction program. Am J Knee Surg. 1998;11:73–79.PubMedGoogle Scholar
  20. 20.
    Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.PubMedCrossRefGoogle Scholar
  21. 21.
    Lewis JL, Askew MJ, Jaycox DP. A comparative evaluation of tibial component designs of total knee prostheses. J Bone Joint Surg Am. 1982;64:129–135.PubMedGoogle Scholar
  22. 22.
    L’Insalata J, Stern S, Insall J. Total knee arthroplasty in elderly patients: comparison of tibial component designs. J Arthroplasty. 1992;7:261–266.PubMedCrossRefGoogle Scholar
  23. 23.
    Mendenhall S. Where are implant prices going? Orthop Network News. 1996;7:2–6.Google Scholar
  24. 24.
    Mikulak SA, Mahoney OM, dela Rosa MA, Schmalzried TP. Loosening and osteolysis with the press-fit condylar posterior-cruciate substituting total knee replacement. J Bone Joint Surg Am. 2001;83:398–403.PubMedGoogle Scholar
  25. 25.
    Muller SD, Deehan DJ, Holland JP, Outterside SE, Kirk LM, Gregg PJ, McCaskie AW. Should we reconsider all-polyethylene tibial implants in total knee replacement? J Bone Joint Surg Br. 2006;88:1596–1602.PubMedGoogle Scholar
  26. 26.
    Najibi S, Iorio R, Surdam JW, Whang W, Appleby D, Healy WL. All polyethylene and metal-backed tibial components in total knee arthroplasty: a matched pair analysis of functional outcome. J Arthroplasty. 2003;18:9–15.PubMedCrossRefGoogle Scholar
  27. 27.
    O’Rourke MR, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC. Osteolysis associated with cemented modular posterior cruciate-substituting total knee design: five to eight-year follow-up. J Bone Joint Surg Am. 2002;84:1362–1371.PubMedGoogle Scholar
  28. 28.
    Pagnano MW, Levy BA, Berry DJ. Cemented all polyethylene tibial components in patients age 75 and older. Clin Orthop Relat Res. 1999;367:73–80.PubMedGoogle Scholar
  29. 29.
    Pomeroy DL, Schaper LA, Badenhausen WE, Suthers KE, Smith MW, Empson JA, Curry JI. Results of all-polyethylene tibial components as a cost-saving technique. Clin Orthop Relat Res. 2000;380:140–143.PubMedCrossRefGoogle Scholar
  30. 30.
    Rana A, Healy WL, Iorio R. Hospital economics of primary total knee arthroplasty at a teaching hospital. Clin Orthop Relat Res. 2011;469:87–94.PubMedCrossRefGoogle Scholar
  31. 31.
    Ranawat CS, Boachie-Ajei O. Survivorship analysis and results of total condylar knee arthroplasty: eight to eleven year followup period. Clin Orthop Relat Res. 1988;226:6–13.PubMedGoogle Scholar
  32. 32.
    Rand JA. Comparison of metal-backed and all polyethylene tibial components in cruciate condylar total knee arthroplasty. J Arthroplasty. 1993;8:307–314.PubMedCrossRefGoogle Scholar
  33. 33.
    Reilly D, Walker PS, Ben-Dov M, Ewald F. Effects of tibial components on load transfer in the upper tibia. Clin Orthop Relat Res. 1982;165:273–282.PubMedGoogle Scholar
  34. 34.
    Rodriguez JA, Baez N, Rashquinha V, Ranawat CS. Metal-backed and all-polyethylene tibial components in total knee replacement. Clin Orthop Relat Res. 2001;392:174–183.PubMedCrossRefGoogle Scholar
  35. 35.
    Schai PA, Thornhill TS, Scott RD. Total knee arthroplasty with the PFC system: results at a minimum of ten years and survivorship analysis. J Bone Joint Surg Am. 1998;80:850–858.CrossRefGoogle Scholar
  36. 36.
    Scuderi GR, Insall JN, Windsor RE, Moran MC. Survivorship of cemented knee replacements. J Bone Joint Surg Br. 1989;71:798–803.PubMedGoogle Scholar
  37. 37.
    Vince KG, Insall JN. Long-term results of cemented total knee arthroplasty. Orthop Clin North Am. 1988;19:575–580.PubMedGoogle Scholar
  38. 38.
    Walker PS, Greene D, Reilly D. Fixation of the tibial components of knee prosthesis. J Bone Joint Surg Am. 1981;63:258–268.PubMedGoogle Scholar
  39. 39.
    Walker PS, Ranawat CS, Insall J. Fixation of the tibial components of condylar knee prosthesis. J Biomech. 1976;9:269–275.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryLahey Clinic Medical CenterBurlingtonUSA

Personalised recommendations