Skip to main content
SpringerLink
Log in

All-polyethylene versus metal-backed tibial component in total knee arthroplasty

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

Abstract

Purpose

The aim of this systematic review was to evaluate the clinical outcomes, rate of revisions and complications of all-polyethylene tibial and metal-backed tibial components in patients treated with knee arthroplasty for primary or secondary osteoarthritis.

Methods

A systematic review of the literature according to the PRISMA guidelines was performed. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the keywords such as “knee”, “arthroplasty”, “metal-backed”, and “all-polyethylene”, since inception of databases to 2016, was performed.

Results

Thirty-two articles, describing patients with all-polyethylene tibial or metal-backed tibial components in the setting of osteoarthritis, were included. A total of 68,202 knees in 58,942 patients were included, with an average age at surgery of 69.3 years, ranging from a mean age of 57.9–82 years. The mean KSS was 82.4 and 81.3 (n.s.), the mean KSS(F) was 73.6 and 74.9 (p = 0.04), the mean ROM was 104.5 and 104.6 (n.s.), and the mean HSS was 87 and 86, each, respectively, for the metal-backed tibial components group and all-polyethylene tibial components group. The overall rate of revisions was 1.90 %. The rate of revision in the metal-backed tibial components group was 1.85 %, whilst the rate of revision in the all-polyethylene tibial components group was 2.02 % (p < 0.00001).

Conclusion

Metal-backed tibial and all-polyethylene tibial components did not show any significant difference in most of the included outcome scores, but statistical differences were found in terms of complications and revision rate. These items have a negative impact on the cost-effectiveness of all-polyethylene tibial components. Even if all-polyethylene tibial components show similar clinical outcome score, equivalent range of knee motion, and long-term survival compared to metal-backed tibial components, complications and revision rate seem to lead the surgeon to prefer the last ones. The clinical relevance of this study is that metal-backed tibial components should be preferred in TKA surgery because complications are higher using all-polyethylene tibial components. On the other hand, the quality of evidence, according to GRADE system, is low underling the necessity of more randomised study to clarify these items.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Adalberth G, Nilsson KG, Byström S, Kolstad K, Milbrink J (2000) Low-conforming all-polyethylene tibial component not inferior to metal-backed component in cemented total knee arthroplasty: prospective, randomized radiostereometric analysis study of the AGC total knee prosthesis. J Arthroplasty 15(6):783–792

    Article  CAS  PubMed  Google Scholar 

  2. Adalberth GA, Nilsson KGA, Bystrom SA, Kolstad KA, Milbrink JA (2001) All-polyethylene versus metal-backed and stemmed tibial components in cemented total knee arthroplasty. A prospective, randomised RSA study. J Bone Joint Surg Br 83(6):825–831

    Article  CAS  PubMed  Google Scholar 

  3. Apel DM, Tozzi JM, Dorr LD (1991) Clinical comparison of all-polyethylene and metal-backed tibial components in total knee arthroplasty. Clin Orthop Relat Res 273:243–252

    Google Scholar 

  4. Bettinson KA, Pinder IM, Moran CG, Weir DJ, Lingard EA (2009) All-polyethylene compared with metal-backed tibial components in total knee arthroplasty at 10 years: a prospective, randomized controlled trial. J Bone Joint Surg Am 91-A(7):1587–1594

    Article  Google Scholar 

  5. Cheng T, Pan X, Liu T, Zhang X (2012) Tibial component designs in primary total knee arthroplasty: should we reconsider all-polyethylene component? Knee Surg Sports Traumatol Arthrosc 20(8):1438–1449

    Article  PubMed  Google Scholar 

  6. Dojcinovic S, Ait Si Selmi T, Servien E, Verdonk PCM, Neyret P (2007) A comparison of all-polyethylene and metal-backed tibial components in total knee arthroplasty. Rev Chir Orthop Reparatrice Appar Mot 93(4):364–372

    Article  CAS  PubMed  Google Scholar 

  7. Doran J, Yu S, Smith D, Iorio R (2015) The role of all-polyethylene tibial components in modern TKA. J Knee Surg 28(5):382–389

    Article  PubMed  Google Scholar 

  8. Enea D, Cigna V, Sgolacchia C, Tozzi L, Verdenelli A, Gigante A (2015) Retained versus resected posterior cruciate ligament in mobile-bearing total knee replacement: a retrospective, clinical and functional assessment. Musculoskelet Surg 99(2):149–154

    Article  CAS  PubMed  Google Scholar 

  9. Font-Rodriguez DE, Scuderi GR, Insall JN (1997) Survivorship of cemented total knee arthroplasty. Clin Orthop Relat Res 345:79–86

    Article  Google Scholar 

  10. Gioe TJ, Bowman KR (2000) A randomized comparison of all-polyethylene and metal-backed tibial components. Clin Orthop Relat Res 380:108–115

    Article  Google Scholar 

  11. Gioe TJ, Sinner PF, Mehle SF, Ma WF, Killeen KK (2007) Excellent survival of all-polyethylene tibial components in a community joint registry. Clin Orthop Relat Res 464:88–92

    PubMed  Google Scholar 

  12. Gioe TJ, Stroemer ES, Santos ERG (2007) All-polyethylene and metal-backed tibias have similar outcomes at 10 Years: a randomized Level I Evidence Study. Clin Orthop Relat Res 455:212–218

    Article  PubMed  Google Scholar 

  13. Gladnick BP, Nam D, Khamaisy S, Paul S, Pearle AD (2015) Onlay tibial implants appear to provide superior clinical results in robotic unicompartmental knee arthroplasty. HSS J 11(1):43–49

    Article  PubMed  Google Scholar 

  14. Gudnason AA, Hailer NPA, W-Dahl AA, Sundberg MA, Robertsson OA (2014) All-polyethylene versus metal-backed tibial components: an analysis of 27,733 cruciate-retaining total knee replacements from the swedish knee arthroplasty register. J Bone Joint Surg Am 96(12):994–999

    Article  PubMed  Google Scholar 

  15. Hsu H, Garg A, Walker P (1989) Effect of knee component alignment on tibial load distribution with clinical correlation. Clin Orthop Relat Res 248:135–144

    Google Scholar 

  16. Hutt JRB, Farhadnia P, Massé 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(6):786–792

    Article  CAS  PubMed  Google Scholar 

  17. Hyldahl H, Regnér L, Carlsson L, Kärrholm J, Weidenhielm L (2005) All-polyethylene versus metal-backed tibial component in total knee arthroplasty-a randomized RSA study comparing early fixation of horizontally and completely cemented tibial components: part 2. Completely cemented components: MB not superior to AP components. Acta Orthop 76(6):778–784

    Article  PubMed  Google Scholar 

  18. Hyldahl HA, Regnér LA, Carlsson LA, Kärrholm JA, Weidenhielm LA (2005) All-polyethylene versus metal-backed tibial component in total knee arthroplasty-a randomized RSA study comparing early fixation of horizontally and completely cemented tibial components: part 1. Horizontally cemented components: AP better fixated than MB. Acta Orthop 76(6):769–777

    Article  PubMed  Google Scholar 

  19. Kalisvaart MM, Pagnano MW, Trousdale RT, Stuart MJ, Hanssen AD (2012) Randomized clinical trial of rotating-platform and fixed-bearing total knee arthroplasty: no clinically detectable differences at 5 years. J Bone Joint Surg Am 94(6):481–489

    Article  PubMed  Google Scholar 

  20. Khanna A, Gougoulias N, Longo UG, Maffulli N (2009) Minimally invasive total knee arthroplasty: a systematic review. Orthop Clin North Am 40(4):479–489

    Article  PubMed  Google Scholar 

  21. L’Insalata JL, Stern SH, Insall JN (1992) Total knee arthroplasty in elderly patients. Comparison of tibial component designs. J Arthroplasty 7(3):261–266

    Article  PubMed  Google Scholar 

  22. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62(10):1–34

    Article  Google Scholar 

  23. Longo UG, Maffulli N, Denaro V (2009) Minimally invasive total knee arthroplasty. N Engl J Med 361(6):633–634

    Article  CAS  PubMed  Google Scholar 

  24. Ma H-M, Lu Y-C, Ho F-Y, Huang C-H (2005) Long-term results of total condylar knee arthroplasty. J Arthroplasty 20(5):580–584

    Article  PubMed  Google Scholar 

  25. Mendenhall S (2011) The 2011 US knee implant price comparison. Orthop Netw News 22(3):18

    Google Scholar 

  26. Mohan V, Inacio MCS, 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

    Article  PubMed  PubMed Central  Google Scholar 

  27. Muller SD, Deehan DJ, Holland JP, Outterside SE, Kirk LMG, Gregg PJ, McCaskie AW (2006) Should we reconsider all-polyethylene tibial implants in total knee replacement? J Bone Joint Surg Br 88(12):1596–1602

    Article  CAS  PubMed  Google Scholar 

  28. Murray DW, MacLennan GS, Breeman S, Dakin HA, Johnston L, Campbell MK, Gray AM, Fiddian N, Fitzpatrick R, Morris RW, Grant AM (2014) A randomised controlled trial of the clinical effectiveness and cost-effectiveness of different knee prostheses: the Knee Arthroplasty Trial (KAT). Health Technol Assess 18(19):1–235

    Article  PubMed  PubMed Central  Google Scholar 

  29. Najibi S, Iorio R, Surdam JW, Whang W, Appleby D, Healy WL (2003) All-polyethylene and metal-backed tibial components in total knee arthroplasty: a matched pair analysis of functional outcome. J Arthroplasty 18(7 Suppl 1):9–15

    Article  PubMed  Google Scholar 

  30. Norgren BA, Dalen TA, Nilsson KGA (2004) All-poly tibial component better than metal-backed: a randomized RSA study. Knee 11(3):189–196

    Article  CAS  PubMed  Google Scholar 

  31. Nouta KA, Verra WC, Pijls BG, Schoones JW, Nelissen RGHH (2012) All-polyethylene tibial components are equal to metal-backed components: systematic review and meta-regression. Clin Orthop Relat Res 470(12):3549–3559

    Article  PubMed  PubMed Central  Google Scholar 

  32. O’Rourke MR, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC (2002) Osteolysis associated with a cemented modular posterior-cruciate-substituting total knee design: five to eight-year follow-up. J Bone Joint Surg Am 84-A(8):1362–1371

    Article  PubMed  Google Scholar 

  33. Pagnano MW, Levy BA, Berry DJ, Berry DJ (1999) Cemented all polyethylene tibial components in patients age 75 years and older. Clin Orthop Relat Res 367:73–80

    Google Scholar 

  34. Pandit H, Spiegelberg B, Clave A, McGrath C, Liddle AD, Murray DW (2016) Aetiology of lateral progression of arthritis following Oxford medial unicompartmental knee replacement: a case-control study. Musculoskelet Surg. doi:10.1007/s12306-015-0394-8 [Epub ahead of print]

    PubMed  PubMed Central  Google Scholar 

  35. Pomeroy DL, Schaper LA, Badenhausen WE, Suthers KE, Smith MW, Empson JA, Curry JI (2000) Results of all-polyethylene tibial components as a cost-saving technique. Clin Orthop Relat Res 380:140–143

    Article  Google Scholar 

  36. Rand JA (1993) Comparison of metal-backed and all-polyethylene tibial components in cruciate condylar total knee arthroplasty. J Arthroplasty 8(3):307–313

    Article  CAS  PubMed  Google Scholar 

  37. Robinson RP, Green TM (2011) Eleven-year implant survival rates of the all-polyethylene and metal-backed modular optetrak posterior stabilized knee in bilateral simultaneous cases. J Arthroplasty 26(8):1165–1169

    Article  PubMed  Google Scholar 

  38. Rodriguez J, Baez N, Rasquinha V, Ranawat C (2001) Metal-backed and all-polyethylene tibial components in total knee replacement. Clin Orthop Relat Res 392:174–183

    Article  Google Scholar 

  39. Shen B, Yang J, Zhou Z, Kang P, Wang L, Pei F (2009) Survivorship comparison of all-polyethylene and metal-backed tibial components in cruciate-substituting total knee arthroplasty—Chinese experience. Int Orthop 33(5):1243–1247

    Article  PubMed  Google Scholar 

  40. Toman J, Iorio R, Healy WL (2012) All-polyethylene and Metal-backed tibial components are equivalent with BMI of <37.5. Clin Orthop Relat Res 470(1):108–116

    Article  PubMed  Google Scholar 

  41. Udomkiat P, Dorr LD, Long W (2001) Matched-pair analysis of all-polyethylene versus metal-backed tibial components. J Arthroplasty 16(6):689–696

    Article  CAS  PubMed  Google Scholar 

  42. 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

    Article  PubMed  Google Scholar 

  43. Waddell DD, Sedacki K, Yang Y, Fitch DA (2015) Early radiographic and functional outcomes of a cancellous titanium-coated tibial component for total knee arthroplasty. Musculoskelet Surg 100(1):71–74

    Article  PubMed  PubMed Central  Google Scholar 

  44. Wright T, Rimnac C, Stulber S, Mintz L, Tsao A, Klein R, McCrae C (1992) Wear of polyethylene in total joint replacements. Observations from retrieved PCA knee implants. Clin Orthop Relat Res 276:126–134

    Google Scholar 

  45. Yassin M, Garti A, Weissbrot M, Ashkenazi U, Khatib M, Robinson D (2015) All-polyethylene tibial components are not inferior to metal-backed tibial components in long-term follow-up of knee arthroplasties. Eur J Orthop Surg Traumatol 25(6):1087–1091

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy

    Umile Giuseppe Longo, Mauro Ciuffreda, Valerio D’Andrea, Nicholas Mannering, Joel Locher & Vincenzo Denaro

  2. Melbourne Medical School, University of Melbourne, Melbourne, VIC, 3010, Australia

    Nicholas Mannering

Authors
  1. Umile Giuseppe Longo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mauro Ciuffreda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Valerio D’Andrea
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nicholas Mannering
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joel Locher
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vincenzo Denaro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Umile Giuseppe Longo.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Longo, U.G., Ciuffreda, M., D’Andrea, V. et al. All-polyethylene versus metal-backed tibial component in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25, 3620–3636 (2017). https://doi.org/10.1007/s00167-016-4168-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-016-4168-0

Keywords

Search

Navigation