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An optimum prosthesis combination of low-risk total knee arthroplasty options in all five primary categories of design results in a 60% reduction in revision risk: a registry analysis of 482,373 prostheses

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Decades of innovations in total knee arthroplasty (TKA) design have led to large number of possible prosthesis combinations in regards fixation, posterior stability, bearing mobility, bearing surface, and patella resurfacing, each of which can alter the revision risk. The accumulative effect when the lowest risk combination in each design category, or “Optimum Prosthesis Combination” (OPC) is utilized remains unknown. The purpose of this analysis was to first, identify the OPC and second, to compare the revision risk of a cohort who received the OPC to a cohort who received an Alternative Prosthesis Combination (APC).

Methods

National registry revision risk data for primary TKA for osteoarthritis were obtained from September 1999 to December 2015 for two patient cohorts, those receiving an OPC and those receiving an APC. OPC was defined as TKA with the lowest revision risk option for five primary TKA design categories; fixation, posterior stability, bearing mobility, bearing surface, and patella resurfacing, while APC had one or more higher risk options.

Results

Of the 482,373 included TKA, 42,008 (8.7%) were in the OPC cohort, who received a minimally stabilized, fixed bearing TKA with cross-linked polyethylene with patella resurfacing. Both cohorts had similar demographics. At 10 years, the OPC cohort had a Cumulative Percent Revision of 2.4% (95% CI 2.1, 2.8) compared to 5.5% (95% CI 5.4, 5.6) for the APC cohort. For all patients, revision risk of the APC cohort was higher at all times [151% greater at ≥ 3 years (p < 0.001)]. Loosening/lysis was the most common cause of revision in the ACP cohort (1.1%), while it was the second most common cause in the OPC cohort (0.3%). The increased risk was apparent in all age and gender subgroups, with the highest risk increase seen in males ≥ 65 years.

Conclusions

Patients receiving the lowest risk prosthesis design combination or Optimum Prosthesis Combination TKA had a 60% lower revision risk, with similar demographics to the Alternative Prosthesis Combination TKA.

Level of evidence

III.

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Abbreviations

TKA:

Total knee arthroplasty

OPC:

Optimum prosthesis combination

APC:

Alternative prosthesis combination

OA:

Osteoarthritis

AOANJRR:

Australian Orthopaedic Association National Joint Replacement Registry

PS:

Posterior stabilized

MS:

Minimally stabilized

CR:

Cruciate retaining

UC:

Ultra-congruent

FB:

Fixed bearing

MB:

Mobile bearing

XLPE:

Cross-linked polyethylene

NXLPE:

Non-cross-linked polyethylene

CoCr:

Cobalt-chrome

CPR:

Cumulative percent revision

CI:

Confidence interval

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Acknowledgements

The authors wish to thank the Australian Orthopaedic Association National Joint Replacement Registry and the hospitals, orthopaedic surgeons, and patients whose data made this work possible.

Funding

The AOANJRR is funded by the Commonwealth Department of Health, Australian Federal Government.

Author information

Authors and Affiliations

  1. Knee Research Australia, 8-10 Carrara Street, Benowa, QLD, 4217, Australia

    Christopher J. Vertullo

  2. Gold Coast Orthopaedic Research and Education Alliance, Menzies Health Institute Queensland, Griffith University, Southport, QLD, 4222, Australia

    Christopher J. Vertullo

  3. Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia

    Stephen E. Graves, Yi Peng & Peter L. Lewis

Authors
  1. Christopher J. Vertullo
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  2. Stephen E. Graves
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  4. Peter L. Lewis
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Contributions

CV conceived of the study and was responsible for study design, data interpretation, data analysis and the first draft of this work. YP provided statistical expertise and data analysis. PL, and SG edited the article, provided data interpretation and conceptual advice. All authors approved the final version of this paper. CV, YP, PL and SG had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Christopher J. Vertullo.

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Conflict of interest

No competing interests exist. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical approval

The ethical conduct of this AOANJRR study was approved by the Australian Federal Government as a Declaration of Quality Assurance Activity under Part VC of the Health Insurance Act, 1973, declaration QAA 14/2014. All investigations were conducted in accordance with ethical principles of research (the Helsinki Declaration II).

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Vertullo, C.J., Graves, S.E., Peng, Y. et al. An optimum prosthesis combination of low-risk total knee arthroplasty options in all five primary categories of design results in a 60% reduction in revision risk: a registry analysis of 482,373 prostheses. Knee Surg Sports Traumatol Arthrosc 27, 1418–1426 (2019). https://doi.org/10.1007/s00167-018-5115-z

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