A team from the Oregon Health and Science University in Portland, Oregon, looked at more than 300,000 total knee arthroplasty cases from the American Joint Replacement Registry and documented all-cause revision cases for older patients.
Their work, “Revision Risk for Total Knee Arthroplasty Polyethylene Designs in Patients 65 Years of Age or Older,” appears in the September 7, 2022, edition of The Journal of Bone and Joint Surgery.
Jamil Kendall, M.D. the primary author on this paper and an orthopedic surgery resident at Oregon Health & Science University in Portland, told OTW, “The American Joint Replacement Registry now has the ability to link to supplemental U.S. Centers for Medicaid and & Medicare Services (CMS) data for outcomes reporting. This allows us to investigate survivorship and compare the association of our different implant choices in total knee arthroplasty.”
The team identified 305,279 cases for the study, 161,486 posterior-stabilized bearings and 143,793 minimally stabilized bearings (81,362 cruciate-retaining, 59,691 anterior-stabilized, and 2,740 pivot. For minimally stabilized bearings, 1,693 cases (1.18%) had all-cause revision and 334 cases (0.23%) had revision due to infection. Regarding posterior-stabilized bearings, 2,406 cases (1.49%) had all-cause revision and 446 cases (0.28%) underwent revision due to infection.
“Posterior stabilized bearing use in total knee arthroplasty was associated with higher all-cause revision rate compared to minimally stabilized bearings,” co-author Ryland Kagan, M.D., assistant professor at Oregon Health & Science University, told OTW.
“Minimally stabilized bearing in this investigation were classic cruciate retaining, or posterior cruciate substituting bearings such as anterior stabilized, or pivot bearing that include medial pivot, dual pivot, and medial congruent. We also compared revision rates among these minimally stabilized bearings and found no differences in revision rates. The association of posterior-stabilized bearings with higher infection for revision was a surprising finding that needs additional investigation.”
“We are already seeing growth of the alternative minimally stabilized bearings, anterior stabilized or pivot,” commented Dr. Kendall to OTW. “Hopefully our study contributes to the body of literature giving surgeons confident that these are at least equivalent in survivorship to cruciate-retaining bearings. Many of these can be posterior cruciate substituting and provide an alternative option for surgeons who currently use posterior-stabilized bearings.”
Dr. Kagan’s message to his colleagues: “Please consider submitting to the American Joint Replacement Registry if your institution is not already participating so we can continue to do more investigations like this.”
