Alternative Bearings in TKA: An Analysis 62,177 Primary Cases from the Kaiser Total Joint Replacement Registry

  • Reference:
  • Inacio MC, Cafri G, Paxton EW, Kurtz SM, Namba RS. Alternative bearings in total knee arthroplasty: risk of early revision compared to traditional bearings: an analysis of 62,177 primary cases. Acta orthopaedica. 2013;84:145-52.
  • Keywords:
  • HXLPE, knee arthroplasty, TKA, crosslinked UHMWPE, oxidized zirconium, Oxinium
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  • The PDF of this article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited.


BACKGROUND AND PURPOSE: There is no substantial clinical evidence for the superiority of alternative bearings in total knee arthroplasty (TKA). We compared the short-term revision risk in alternative surface bearing knees (oxidized zirconium (OZ) femoral implants or highly crosslinked polyethylene (HXLPE) inserts) with that for traditional bearings (cobalt-chromium (CoCR) on conventional polyethelene (CPE)). The risk of revision with commercially available HXLPE inserts was also evaluated. METHODS: All 62,177 primary TKA cases registered in a Total Joint Replacement Registry between April 2001 and December 2010 were retrospectively analyzed. The endpoints for the analysis were all-cause revisions, septic revisions, or aseptic revisions. Bearing surfaces were categorized as OZ-CPE, CoCr-HXLPE, or CoCr-CPE. HXLPE inserts were stratified according to brand name. Confounding was addressed using propensity score weights. Marginal Cox-regression models adjusting for surgeon clustering were used. RESULTS: The proportion of females was 62%. Average age was 68 (SD 9.3) years, and median follow-up time was 2.8 (IQR 1.2-4.9) years. After adjustments, the risks of all-cause, aseptic, and septic revision with CoCr-HXLPE and OZ-CPE bearings were not statistically significantly higher than with traditional CoCr-CPE bearings. No specific brand of HXLPE insert was associated with a higher risk of all-cause, aseptic, or septic revision compared to CoCr-CPE. INTERPRETATION: At least in the short term, none of the alternative knee bearings evaluated (CoCr-HXLPE or OZ-CPE) had a greater risk of all-cause, aseptic, and septic revision than traditional CoCr-CPE bearings.

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