Lower prosthesis-specific 10-year revision rate with crosslinked than with non-crosslinked polyethylene in primary total knee arthroplasty.
Lower prosthesis-specific 10-year revision rate with crosslinked than with non-crosslinked polyethylene in primary total knee arthroplasty.
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DOI：
10.3109/17453674.2015.1065046
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发表时间：
2015
影响因子：
3.7
通讯作者：
Graves SE
中科院分区：
文献类型：
--
作者：
de Steiger RN;Muratoglu O;Lorimer M;Cuthbert AR;Graves SE
背景和目的-尽管高交联聚乙烯在全髋关节置换术中显示出体内磨损减少和翻修率降低，但在全膝关节置换术（TKA）中使用的长期研究很少。我们比较了因骨关节炎接受TKA的患者中非交联聚乙烯与交联聚乙烯的翻修率。患者和方法-我们检查了来自澳大利亚骨科协会国家关节置换登记处的302，214例非交联聚乙烯初次TKA手术和83，890例交联聚乙烯手术的数据，所有这些手术均用于骨关节炎。使用Kaplan-Meier方法估计不同聚乙烯的生存率，并使用比例风险模型进行比较。结果-非交联聚乙烯的10年累积翻修率为5.8%（95% CI：5.7-6.0），交联聚乙烯为3.5%（95% CI：3.2-3.8）（> 6.5年HR = 2.2（1.5-3.1）; p < 0.001）。手术量或假体固定方法对结果没有影响。有4种不同的TKA设计，至少有1个聚乙烯组进行了至少2,500例手术，随访时间≥ 5年。其中2个，NexGen和Natural Knee II，交联聚乙烯的翻修率较低。Scorpio NRG/7000系列和Triathlon膝关节假体的交联聚乙烯翻修率并不低。解释-TKA中交联聚乙烯的翻修率较低，这似乎是假体特异性的，并且在65岁以下的患者中发生最明显。翻修率的差异主要是由于溶解和松动导致的翻修。
Background and purpose — While highly crosslinked polyethylene has shown reduced in vivo wear and lower rates of revision for total hip arthroplasty, there have been few long-term studies on its use in total knee arthroplasty (TKA). We compared the rate of revision of non-crosslinked polyethylene to that of crosslinked polyethylene in patients who underwent TKA for osteoarthritis. Patients and methods — We examined data from the Australian Orthopaedic Association National Joint Replacement Registry on 302,214 primary TKA procedures with non-crosslinked polyethylene and 83,890 procedures with crosslinked polyethylene, all of which were performed for osteoarthritis. The survivorship of the different polyethylenes was estimated using the Kaplan-Meier method and was compared using proportional hazard models. Results — The 10-year cumulative revision rate for non-crosslinked polyethylene was 5.8% (95% CI: 5.7–6.0) and for crosslinked polyethylene it was 3.5% (95% CI: 3.2–3.8) (> 6.5-year HR = 2.2 (1.5–3.1); p < 0.001). There was no effect of surgical volume or method of prosthesis fixation on outcome. There were 4 different TKA designs that had a minimum of 2,500 procedures in at least 1 of the polyethylene groups and a follow-up of ≥ 5 years. 2 of these, the NexGen and the Natural Knee II, had a lower rate of revision for crosslinked polyethylene. The Scorpio NRG/Series 7000 and the Triathlon Knee did not show a lower rate of revision for crosslinked polyethylene. Interpretation — There is a lower rate of revision for crosslinked polyethylene in TKA, and this appears to be prosthesis-specific and when it occurs is most evident in patients < 65 years of age. The difference in revision rates was mainly due to revisions because of lysis and loosening.