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

Clinical Orthopaedics and Related Research®

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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.

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Author information

Authors and Affiliations

  1. Department of Orthopaedics, Leiden University Medical Center, Postal Code J11R, PO Box 9600, 2300 RC, Leiden, The Netherlands

    Klaas Auke Nouta MD, Wiebe C. Verra MD, Bart G. Pijls MD & Rob G. H. H. Nelissen MD, PhD

  2. Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands

    Jan W. Schoones MA

Authors
  1. Klaas Auke Nouta MD
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  2. Wiebe C. Verra MD
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  3. Bart G. Pijls MD
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  4. Jan W. Schoones MA
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  5. Rob G. H. H. Nelissen MD, PhD
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Corresponding author

Correspondence to Klaas Auke Nouta MD.

Additional information

One or more of the authors (KAN) have received funding for this study from a grant from the Dutch Arthritis Association (Project Number: LLP13; 08-1-300). The fund did not take part in the design or conduct of the study; in the collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript. Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

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Nouta, K.A., Verra, W.C., Pijls, B.G. et al. All-polyethylene Tibial Components are Equal to Metal-backed Components: Systematic Review and Meta-regression. Clin Orthop Relat Res 470, 3549–3559 (2012). https://doi.org/10.1007/s11999-012-2582-2

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  • DOI: https://doi.org/10.1007/s11999-012-2582-2

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