TY - JOUR
T1 - No Reduction in Revision Risk Associated With Highly Cross-linked Polyethylene With or Without Antioxidants Over Conventional Polyetheylene in TKA
T2 - An Analysis From the American Joint Replacement Registry
AU - Kendall, Jamil
AU - Pelt, Christopher E.
AU - Imlay, Benjamin
AU - Yep, Patrick
AU - Mullen, Kyle
AU - Kagan, Ryland
N1 - Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/10/1
Y1 - 2022/10/1
N2 - BackgroundHighly cross-linked polyethylene (HXLPE) can improve wear properties in TKA, but it can also lead to decreased mechanical properties. Antioxidants were added to HXLPE to improve its mechanical properties while retaining the improved wear characteristics. However, it remains unclear whether these modifications to conventional polytheylene used in TKA have resulted in a change in the revision risk.Questions/purposesWe used American Joint Replacement Registry data to ask: (1) Is there a difference in all-cause revision in patients who underwent TKA using HXLPE with or without an antioxidant doping compared with conventional polyethylene? (2) Is there a difference in revision for aseptic failure in patients who underwent TKA using HXLPE with or without an antioxidant doping compared with conventional polyethylene?MethodsWe analyzed American Joint Replacement Registry data from 2012 to 2019. We identified 339,366 primary TKAs over the study period in patients older than 65 years and linked procedures to supplemental Centers for Medicare & Medicaid data where available. Patient total number of reported comorbidities, gender, age, region, polyethylene characteristics, procedure dates, and indication for revision were recorded. Median follow-up was 34 months. We compared HXLPE with or without antioxidants to conventional polyethylene. Event-free percent survival curves and Cox proportional hazard regression modeling was used for all-cause revision and revision for aseptic failure.ResultsCompared with conventional polyethylene, there was no difference in all-cause revision with HXLPE with an antioxidant (HR 1.06 [95% CI 0.98 to 1.14]; p = 0.13) or HXLPE without an antioxidant (HR 1.04 [95% CI 0.97 to 1.11]; p = 0.28). Compared with conventional polyethylene, there was no difference in revision for aseptic failure with HXLPE with an antioxidant (HR 1.07 [95% CI 0.99 to 1.14]; p = 0.08) or HXLPE without an antioxidant (HR 1.03 [95% CI 0.97 to 1.01]; p = 0.30).ConclusionWe found no difference in revision risk between HXLPE with or without an antioxidant and conventional polyethylene during this time frame. HXLPE polyethylene, with or without an antioxidant, should not be widely adopted until or unless it is shown to be superior to conventional polyethylene in TKA.Level of EvidenceLevel III, therapeutic study.
AB - BackgroundHighly cross-linked polyethylene (HXLPE) can improve wear properties in TKA, but it can also lead to decreased mechanical properties. Antioxidants were added to HXLPE to improve its mechanical properties while retaining the improved wear characteristics. However, it remains unclear whether these modifications to conventional polytheylene used in TKA have resulted in a change in the revision risk.Questions/purposesWe used American Joint Replacement Registry data to ask: (1) Is there a difference in all-cause revision in patients who underwent TKA using HXLPE with or without an antioxidant doping compared with conventional polyethylene? (2) Is there a difference in revision for aseptic failure in patients who underwent TKA using HXLPE with or without an antioxidant doping compared with conventional polyethylene?MethodsWe analyzed American Joint Replacement Registry data from 2012 to 2019. We identified 339,366 primary TKAs over the study period in patients older than 65 years and linked procedures to supplemental Centers for Medicare & Medicaid data where available. Patient total number of reported comorbidities, gender, age, region, polyethylene characteristics, procedure dates, and indication for revision were recorded. Median follow-up was 34 months. We compared HXLPE with or without antioxidants to conventional polyethylene. Event-free percent survival curves and Cox proportional hazard regression modeling was used for all-cause revision and revision for aseptic failure.ResultsCompared with conventional polyethylene, there was no difference in all-cause revision with HXLPE with an antioxidant (HR 1.06 [95% CI 0.98 to 1.14]; p = 0.13) or HXLPE without an antioxidant (HR 1.04 [95% CI 0.97 to 1.11]; p = 0.28). Compared with conventional polyethylene, there was no difference in revision for aseptic failure with HXLPE with an antioxidant (HR 1.07 [95% CI 0.99 to 1.14]; p = 0.08) or HXLPE without an antioxidant (HR 1.03 [95% CI 0.97 to 1.01]; p = 0.30).ConclusionWe found no difference in revision risk between HXLPE with or without an antioxidant and conventional polyethylene during this time frame. HXLPE polyethylene, with or without an antioxidant, should not be widely adopted until or unless it is shown to be superior to conventional polyethylene in TKA.Level of EvidenceLevel III, therapeutic study.
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U2 - 10.1097/CORR.0000000000002338
DO - 10.1097/CORR.0000000000002338
M3 - Article
C2 - 35994277
AN - SCOPUS:85138457674
SN - 0009-921X
VL - 480
SP - 1929
EP - 1936
JO - Clinical orthopaedics and related research
JF - Clinical orthopaedics and related research
IS - 10
ER -