All-polyethylene tibia components have the same functional outcomes and survival, and are more cost-effective than metal-backed components in patients 70 years and older undergoing total knee arthroplasty <subtitle>propensity match study with a minimum five-year follow-up</subtitle>
AimsThe tibial component of total knee arthroplasty can either be an all-polyethylene (AP) implant or a metal-backed (MB) implant. This study aims to compare the five-year functional outcomes of AP tibial components to MB components in patients aged over 70 years. Secondary aims are to compare quali...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
The British Editorial Society of Bone & Joint Surgery
2022-12-01
|
| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/10.1302/2633-1462.312.BJO-2022-0063.R1 |
| _version_ | 1797979438848147456 |
|---|---|
| author | Monu Jabbal Nick Clement Phil J. Walmsley |
| author_facet | Monu Jabbal Nick Clement Phil J. Walmsley |
| author_sort | Monu Jabbal |
| collection | DOAJ |
| description | AimsThe tibial component of total knee arthroplasty can either be an all-polyethylene (AP) implant or a metal-backed (MB) implant. This study aims to compare the five-year functional outcomes of AP tibial components to MB components in patients aged over 70 years. Secondary aims are to compare quality of life, implant survivorship, and cost-effectiveness.MethodsA group of 130 patients who had received an AP tibial component were matched for demographic factors of age, BMI, American Society of Anesthesiologists (ASA) grade, sex, and preoperative Knee Society Score (KSS) to create a comparison group of 130 patients who received a MB tibial component. Functional outcome was assessed prospectively by KSS, quality of life by 12-Item Short-Form Health Survey questionnaire (SF-12), and range of motion (ROM), and implant survivorships were compared. The SF six-dimension (6D) was used to calculate the incremental cost effectiveness ratio (ICER) for AP compared to MB tibial components using quality-adjusted life year methodology.ResultsThe AP group had a mean KSS-Knee of 83.4 (standard deviation (SD) 19.2) and the MB group a mean of 84.9 (SD 18.2; p = 0.631), while mean KSS-Function was 75.4 (SD 15.3) and 73.2 (SD 16.2 p = 0.472), respectively. The mental (44.3 vs 45.1; p = 0.464) and physical (44.8 vs 44.9; p = 0.893) dimensions of the SF-12 and ROM (97.9° vs 99.7°; p = 0.444) were not different between the groups. Implant survivorship at five years were 99.2% and 97.7% (p = 0.321). The AP group had a greater SF-6D gain of 0.145 compared to the MB group, with an associated cost saving of £406, which resulted in a negative ICER of -£406/0.145 = -£2,800. Therefore, the AP tibial component was dominant, being a more effective and less expensive intervention.ConclusionThere were no differences in functional outcomes or survivorship at five years between AP and MB tibial components in patients aged 70 years and older, however the AP component was shown to be more cost-effective. In the UK, only 1.4% of all total knee arthroplasties use an AP component; even a modest increase in usage nationally could lead to significant financial savings.Cite this article: Bone Jt Open 2022;3(12):969–976. |
| first_indexed | 2024-04-11T05:39:01Z |
| format | Article |
| id | doaj.art-4ed7e80bb9724de38c1666b26de3dc1b |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-04-11T05:39:01Z |
| publishDate | 2022-12-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-4ed7e80bb9724de38c1666b26de3dc1b2022-12-22T09:52:01ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622022-12-0131296997610.1302/2633-1462.312.BJO-2022-0063.R1All-polyethylene tibia components have the same functional outcomes and survival, and are more cost-effective than metal-backed components in patients 70 years and older undergoing total knee arthroplasty <subtitle>propensity match study with a minimum five-year follow-up</subtitle>Monu Jabbal0Nick Clement1Phil J. Walmsley2Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UKEdinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UKDepartment of Orthopaedic Surgery, Victoria Hospital, Kirkcaldy, UKAimsThe tibial component of total knee arthroplasty can either be an all-polyethylene (AP) implant or a metal-backed (MB) implant. This study aims to compare the five-year functional outcomes of AP tibial components to MB components in patients aged over 70 years. Secondary aims are to compare quality of life, implant survivorship, and cost-effectiveness.MethodsA group of 130 patients who had received an AP tibial component were matched for demographic factors of age, BMI, American Society of Anesthesiologists (ASA) grade, sex, and preoperative Knee Society Score (KSS) to create a comparison group of 130 patients who received a MB tibial component. Functional outcome was assessed prospectively by KSS, quality of life by 12-Item Short-Form Health Survey questionnaire (SF-12), and range of motion (ROM), and implant survivorships were compared. The SF six-dimension (6D) was used to calculate the incremental cost effectiveness ratio (ICER) for AP compared to MB tibial components using quality-adjusted life year methodology.ResultsThe AP group had a mean KSS-Knee of 83.4 (standard deviation (SD) 19.2) and the MB group a mean of 84.9 (SD 18.2; p = 0.631), while mean KSS-Function was 75.4 (SD 15.3) and 73.2 (SD 16.2 p = 0.472), respectively. The mental (44.3 vs 45.1; p = 0.464) and physical (44.8 vs 44.9; p = 0.893) dimensions of the SF-12 and ROM (97.9° vs 99.7°; p = 0.444) were not different between the groups. Implant survivorship at five years were 99.2% and 97.7% (p = 0.321). The AP group had a greater SF-6D gain of 0.145 compared to the MB group, with an associated cost saving of £406, which resulted in a negative ICER of -£406/0.145 = -£2,800. Therefore, the AP tibial component was dominant, being a more effective and less expensive intervention.ConclusionThere were no differences in functional outcomes or survivorship at five years between AP and MB tibial components in patients aged 70 years and older, however the AP component was shown to be more cost-effective. In the UK, only 1.4% of all total knee arthroplasties use an AP component; even a modest increase in usage nationally could lead to significant financial savings.Cite this article: Bone Jt Open 2022;3(12):969–976.https://online.boneandjoint.org.uk/doi/10.1302/2633-1462.312.BJO-2022-0063.R1All polyethyleneTotal knee arthroplastyHealth economicsfunctional outcome scoresPolyethylenemetal |
| spellingShingle | Monu Jabbal Nick Clement Phil J. Walmsley All-polyethylene tibia components have the same functional outcomes and survival, and are more cost-effective than metal-backed components in patients 70 years and older undergoing total knee arthroplasty <subtitle>propensity match study with a minimum five-year follow-up</subtitle> Bone & Joint Open All polyethylene Total knee arthroplasty Health economics functional outcome scores Polyethylene metal |
| title | All-polyethylene tibia components have the same functional outcomes and survival, and are more cost-effective than metal-backed components in patients 70 years and older undergoing total knee arthroplasty <subtitle>propensity match study with a minimum five-year follow-up</subtitle> |
| title_full | All-polyethylene tibia components have the same functional outcomes and survival, and are more cost-effective than metal-backed components in patients 70 years and older undergoing total knee arthroplasty <subtitle>propensity match study with a minimum five-year follow-up</subtitle> |
| title_fullStr | All-polyethylene tibia components have the same functional outcomes and survival, and are more cost-effective than metal-backed components in patients 70 years and older undergoing total knee arthroplasty <subtitle>propensity match study with a minimum five-year follow-up</subtitle> |
| title_full_unstemmed | All-polyethylene tibia components have the same functional outcomes and survival, and are more cost-effective than metal-backed components in patients 70 years and older undergoing total knee arthroplasty <subtitle>propensity match study with a minimum five-year follow-up</subtitle> |
| title_short | All-polyethylene tibia components have the same functional outcomes and survival, and are more cost-effective than metal-backed components in patients 70 years and older undergoing total knee arthroplasty <subtitle>propensity match study with a minimum five-year follow-up</subtitle> |
| title_sort | all polyethylene tibia components have the same functional outcomes and survival and are more cost effective than metal backed components in patients 70 years and older undergoing total knee arthroplasty subtitle propensity match study with a minimum five year follow up subtitle |
| topic | All polyethylene Total knee arthroplasty Health economics functional outcome scores Polyethylene metal |
| url | https://online.boneandjoint.org.uk/doi/10.1302/2633-1462.312.BJO-2022-0063.R1 |
| work_keys_str_mv | AT monujabbal allpolyethylenetibiacomponentshavethesamefunctionaloutcomesandsurvivalandaremorecosteffectivethanmetalbackedcomponentsinpatients70yearsandolderundergoingtotalkneearthroplastysubtitlepropensitymatchstudywithaminimumfiveyearfollowupsubtitle AT nickclement allpolyethylenetibiacomponentshavethesamefunctionaloutcomesandsurvivalandaremorecosteffectivethanmetalbackedcomponentsinpatients70yearsandolderundergoingtotalkneearthroplastysubtitlepropensitymatchstudywithaminimumfiveyearfollowupsubtitle AT philjwalmsley allpolyethylenetibiacomponentshavethesamefunctionaloutcomesandsurvivalandaremorecosteffectivethanmetalbackedcomponentsinpatients70yearsandolderundergoingtotalkneearthroplastysubtitlepropensitymatchstudywithaminimumfiveyearfollowupsubtitle |