Resurrection of all poly tibia
•
1 like•907 views
The document discusses the use of all-polyethylene tibial components in total knee arthroplasty. It provides a history of knee implants, reviews literature comparing all-poly and metal-backed components, and outlines the surgeon's technique for implanting all-poly components. The literature shows all-poly components have equivalent or better long-term results and survivorship compared to metal-backed implants, with less risk of osteolysis. Reasons to consider all-poly include excellent clinical outcomes, lower cost, and avoiding issues like backside wear seen with metal-backed implants.
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Resurrection of all poly tibia
Similar to Resurrection of all poly tibia (20)
Resurrection of all poly tibia
- 1. 1
- 2. Resurrection of the All Poly Tibia Satish G Reddy, M.S, M.Ch Ortho (U.K) Fellow Arthroplasty & Arthroscopy Villis R Marshal Trauma Fellowship Flinders Medical Centre, Adelaide, Australia Fellow Orthopaedic Oncology Institute of Rizzoli, Bologna, Italy Royal Orthopaedic Hospital, Birmingham, U.K 1
- 3. Resurrection of the All Poly Tibia Satish G Reddy, M.S, M.Ch Ortho (U.K) Fellow Arthroplasty & Arthroscopy Villis R Marshal Trauma Fellowship Flinders Medical Centre, Adelaide, Australia Fellow Orthopaedic Oncology Institute of Rizzoli, Bologna, Italy Royal Orthopaedic Hospital, Birmingham, U.K 1
- 4. Goals of TKA • Pain relief • Improve function • Stable knee • One surgery 2
- 5. Goals of TKA • Pain relief • Improve function • Stable knee • One surgery 2
- 6. Topics for today • History • Pro and cons • Literature review • Contraindications • Economics 3
- 7. History • Total Condylar Knee (1973) • Insall Burstein (1980) • Insall Burstein (1984) 4
- 8. Background Why the evolution to Metal backing? • Fewest deflections found in one piece metal backed components • Metal backing desirable for cruciate retaining implants • Thick plastic components behave like metal backed implants 5
- 9. Negative reports All Poly • UCI knee replacement • All poly design • Thing U shaped poly design 5 - 7.5 mm • Limited plateau coverage Hamilton, L.R., JBJS 1982 • Reported a 27% failure rate 6
- 10. Negative reports All Poly • AGC knee replacement • All poly • Flat on flat • PCR with low conformity • Faris et al JBJS • 68% survival in 10 year • Collapse bone beneath medial tibia “Results associated with a! poly tibias are design related” 7
- 11. Negative reports All Poly • Each predicted by Walkers Biomechanical study i.e design related failures • Thick poly components behave like metal backed components except if a cruciate cut out is present 8
- 12. Industry dictates • Make all poly for PS and metal backed for CR • Make one tray to accommodate both 9
- 13. Industry dictates • Make all poly for PS and metal backed for CR • Make one tray to accommodate both 9
- 14. Industry dictates • Make all poly for PS and metal backed for CR • Make one tray to accommodate both 9
- 15. Topics for today • History • Pro and cons • Literature review • Contraindications • Economics 10
- 16. Advantages / Disadvantages Metal backed tibia Advantages • Decreased deflections • Modularity with intraoperative flexibility • Porous coating if desired • Possibility of liner exchange • Potential for minimally invasive techniques • Smaller inventory • Allows for cementless fixation • Excellent clinical results and longterm survivor ship 11
- 17. Advantages / Disadvantages Metal backed tibia Disadvantages • Micromotion between poly & tray • Locking issues and backside wear • Higher prevalence of osteolysis • Increased cost • Decreased poly thickness • Relative difficulty with isolated tibial revision 12
- 18. Advantages / Disadvantages Metal backed tibia Disadvantages • Micromotion between poly & tray • Locking issues and backside wear • Higher prevalence of osteolysis • Increased cost • Decreased poly thickness • Relative difficulty with isolated tibial revision 12
- 19. Advantages / Disadvantages Metal backed tibia Disadvantages • Micromotion between poly & tray • Locking issues and backside wear • Higher prevalence of osteolysis • Increased cost • Decreased poly thickness • Relative difficulty with isolated tibial revision 12
- 20. Advantages / Disadvantages Metal backed tibia Disadvantages • Micromotion between poly & tray • Locking issues and backside wear • Higher prevalence of osteolysis • Increased cost • Decreased poly thickness • Relative difficulty with isolated tibial revision 12
- 21. Advantages / Disadvantages Metal backed tibia Disadvantages • Micromotion between poly & tray • Locking issues and backside wear • Higher prevalence of osteolysis • Increased cost • Decreased poly thickness • Relative difficulty with isolated tibial revision 12
- 22. Advantages / Disadvantages Metal backed tibia Disadvantages • Micromotion between poly & tray • Locking issues and backside wear • Higher prevalence of osteolysis • Increased cost • Decreased poly thickness • Relative difficulty with isolated tibial revision 12
- 23. Advantages / Disadvantages Metal backed tibia Disadvantages • Micromotion between poly & tray • Locking issues and backside wear • Higher prevalence of osteolysis • Increased cost • Decreased poly thickness • Relative difficulty with isolated tibial revision 12
- 24. Advantages / Disadvantages All Poly tibia Advantages • Lack of locking mechanism and backside wear • Excellent clinical results and survivorship • Osteolysis rarely reported • Increased poly thickness for similar resection • Ease of revision • Low cost 13
- 25. Advantages / Disadvantages All Poly tibia Disadvantages • Lack of intraoperative flexibility • Cannot perform poly exchange • No cementless option • potential difficulty in removing posterior extruded cement • Increased inventory 14
- 26. Topics for today • History • Pro and cons • Literature review • Contraindications • Economics 15
- 27. Literature review • Comparative registry data • RSA studies • Critically analyze negative reports • Osteolysis literature 16
- 28. Comparative data • PFC knees • No difference in KSS / radiographic outcome • 10 year survivorship for aseptic loosening - 100% for all poly PCR - 94% metal backed 17
- 29. Registry data • 443 all poly knees • Survival @ 14 years 99.7% • Cumulative revision rate 1% versus 4.9% for 4977 metal backed knees done during the same time frame 18
- 30. RSA data 19
- 31. RSA data • No difference between AP and MB implants in any of the parameters 20
- 32. RSA data All-poly tibial component better than metal-backed: a randomized RSA study B Norgren, T Dalén, K.G Nilsson Received 23 September 2002; received in revised form 3 March 2003; accepted 3 March 2003 Abstract The quality of the fixation of the tibial component in 21 patients (23 knees) undergoing a cemented total-knee arthroplasty of the Profix design was investigated using radiostereometric analysis during 24 months. The patients were randomized to either an all-polyethylene (AP) or a metal-backed (MB) tibial component. The articulating geometry and the stem design of the implants were identical, as were the operative technique and the postoperative regimen. The results showed no negative consequences as regards fixation using AP tibial components. In all aspects, the AP components displayed magnitudes of migration on par with, or sometimes even lower than their MB counterparts. Five of 11 MB components displayed continuous migration between 1 and 2 years, compared to none of the AP implants, a finding known to be of positive prognostic significance when predicting future aseptic loosening. 21
- 33. Meta analysis 22
- 34. RCT 23
- 35. Meta analysis 24
- 36. All poly in Rheumatoid 25
- 37. All Poly in young The Journal of Arthroplasty Volume 20, Supplement 3 , Pages 7-11, October 2005 Experience With an All-Polyethylene Total Knee Arthroplasty in Younger, Active Patients With Follow-up From 2 to 11 Years • Amar S. Ranawat, MD, Shubhranshu S. Mohanty, MD, Scott E. Goldsmith, MD, Vijay J. Rasquinha, MD, Jose A. Rodriguez, MD, Chitranjan S. Ranawat, MD “Our clinical experience indicates that an all-poly tibial component fixed with cement can provide excellent performance and survivorship even in younger, active patients at intermediate follow-up”. 26
- 38. Osteolysis literature 27
- 39. Osteolysis literature • Non existent for all poly tibia 27
- 40. Osteolysis literature 27
- 41. Topics for today • History • Pro and cons • Literature review • Contraindications • Economics 28
- 42. Barriers to use 29
- 43. Barriers to use • Surgeons technique 29
- 44. Barriers to use • Surgeons technique • Femur first 29
- 45. Barriers to use • Surgeons technique • Femur first • Needs adequate exposure 29
- 46. Barriers to use • Surgeons technique • Femur first • Needs adequate exposure • Lack of intraoperative flexibility 29
- 47. Barriers to use • Surgeons technique • Femur first • Needs adequate exposure • Lack of intraoperative flexibility • Adjust poly thickness after cementation 29
- 48. Barriers to use • Surgeons technique • Femur first • Needs adequate exposure • Lack of intraoperative flexibility • Adjust poly thickness after cementation • Industry pressure 29
- 49. Topics for today • History • Pro and cons • Literature review • Contraindications • Economics 30
- 50. Economics • Control costs • Implant cost is a big percentage of total cost • If results are equivalent all poly tibias should be considered 31
- 51. Practical algorithm • Active patients < age 60 • Metal backed tibial component • Patients > age 60 • non obese • good bone stock • good stability and balance with trail implants • ability to access tibia with femoral component on 32
- 52. Personal experience • Used all poly tibia in patients > age 60 since 2007 • no revisions for loosening • no revisions for instability • no progressive RLL 33
- 53. My typical steps • IV 1st generation cephalosporin for 48 hrs • Gentamycin if catherterising • Trenaxamic acid 2 gm IV • Tourniquet control • Medial parapatellar approach 34
- 54. My typical steps • Excise fat pad, menisci, cruciates • Medial release, osteophytectomy • Tibial cut 10mm, 90 degrees to mechanical axis • 7 degrees of femoral valgus • Trail implants, free float • Tibial preparation 35
- 55. My typical steps • Pulsavac, Antibiotic loaded cement • Femur first, tibia next • Knee extension as cement sets • Layered closure, no drain • IA trenaxemic acid 2gm • LMWH for 5 days • Mobilise 1st POD 36
- 56. Conclusion 37
- 57. Conclusion Reasons to consider all poly 37
- 58. Conclusion Reasons to consider all poly • Excellent long term results 37
- 59. Conclusion Reasons to consider all poly • Excellent long term results • Lower costs 37
- 60. Conclusion Reasons to consider all poly • Excellent long term results • Lower costs • No backside wear / osteolysis 37
- 61. Conclusion Reasons to consider all poly • Excellent long term results • Lower costs • No backside wear / osteolysis • Give up intra op flexibility 37
- 62. Conclusion Reasons to consider all poly • Excellent long term results • Lower costs • No backside wear / osteolysis • Give up intra op flexibility Treat the patient, not the doctor 37
- 63. Prime Hospitals Hyderabad Thank You 38