Association Between Surface Modifications for Biologic Fixation and Aseptic Loosening of Uncemented Total Knee Arthroplasties

Raymond Puijk; Rachid Rassir; Inger N. Sierevelt; Anneke Spekenbrink-Spooren; Rob G.H.H. Nelissen; Peter A. Nolte

doi:10.1016/j.arth.2023.05.094

Association Between Surface Modifications for Biologic Fixation and Aseptic Loosening of Uncemented Total Knee Arthroplasties

Raymond Puijk^*, Rachid Rassir, Inger N. Sierevelt, Anneke Spekenbrink-Spooren, Rob G.H.H. Nelissen, Peter A. Nolte

^*Corresponding author for this work

Oral Cell Biology

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Background: Various surface modifications are used in uncemented total knee arthroplasties (TKAs) to enhance bony ingrowth and longevity of implants. This study aimed to identify which surface modifications are used, whether they are associated with different revision rates for aseptic loosening, and which are underperforming compared to cemented implants. Methods: Data on all cemented and uncemented TKAs used between 2007 and 2021 were obtained from the Dutch Arthroplasty Register. Uncemented TKAs were divided into groups based on their surface modifications. Revision rates for aseptic loosening and major revisions were compared between groups. Kaplan-Meier, Competing-Risk, Log-rank tests, and Cox regression analyses were used. In total, 235,500 cemented and 10,749 uncemented primary TKAs were included. The different uncemented TKA groups included the following: 1,140 porous-hydroxyapatite (HA); 8,450 Porous-uncoated; 702 Grit-blasted-uncoated; and 172 Grit-blasted-Titanium-nitride (TiN) implants. Results: The 10-year revision rates for aseptic loosening and major revision of the cemented TKAs were 1.3 and 3.1%, and for uncemented TKAs 0.2 and 2.3% (porous-HA), 1.3 and 2.9% (porous-uncoated), 2.8 and 4.0% (grit-blasted-uncoated), and 7.9% and 17.4% (grit-blasted-TiN), respectively. Both type of revision rates varied significantly between the uncemented groups (log-rank tests, P < .001, P < .001). All grit-blasted implants had a significantly higher risk of aseptic loosening (P < .01), and porous-uncoated implants had a significantly lower risk of aseptic loosening than cemented implants (P = .03) after 10 years. Conclusion: There were 4 main uncemented surface modifications identified, with different revision rates for aseptic loosening. Implants with porous-HA and porous-uncoated had the best revision rates, at least equal to cemented TKAs. Grit-blasted implants with and without TiN underperformed, possibly due to the interaction of other factors.

Original language	English
Pages (from-to)	2605-2611.e1
Number of pages	8
Journal	Journal of Arthroplasty
Volume	38
Issue number	12
Early online date	8 Jun 2023
DOIs	https://doi.org/10.1016/j.arth.2023.05.094
Publication status	Published - Dec 2023

Bibliographical note

Funding Information:
This research did not receive any grants or funding. None of the authors declare any competing interests. Ethical approval was not required for this study. Routinely collected data from the LROI were extracted for this study. Ethics approval and consent to participate were not applicable, as all data received was completely anonymous.

Publisher Copyright:
© 2023 Elsevier Inc.

Keywords

biological fixation
coating
register
surface modification
total knee arthroplasty
uncemented

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@article{ad6a8f16b9ef46a7b98dad6fd92a0884,

title = "Association Between Surface Modifications for Biologic Fixation and Aseptic Loosening of Uncemented Total Knee Arthroplasties",

abstract = "Background: Various surface modifications are used in uncemented total knee arthroplasties (TKAs) to enhance bony ingrowth and longevity of implants. This study aimed to identify which surface modifications are used, whether they are associated with different revision rates for aseptic loosening, and which are underperforming compared to cemented implants. Methods: Data on all cemented and uncemented TKAs used between 2007 and 2021 were obtained from the Dutch Arthroplasty Register. Uncemented TKAs were divided into groups based on their surface modifications. Revision rates for aseptic loosening and major revisions were compared between groups. Kaplan-Meier, Competing-Risk, Log-rank tests, and Cox regression analyses were used. In total, 235,500 cemented and 10,749 uncemented primary TKAs were included. The different uncemented TKA groups included the following: 1,140 porous-hydroxyapatite (HA); 8,450 Porous-uncoated; 702 Grit-blasted-uncoated; and 172 Grit-blasted-Titanium-nitride (TiN) implants. Results: The 10-year revision rates for aseptic loosening and major revision of the cemented TKAs were 1.3 and 3.1%, and for uncemented TKAs 0.2 and 2.3% (porous-HA), 1.3 and 2.9% (porous-uncoated), 2.8 and 4.0% (grit-blasted-uncoated), and 7.9% and 17.4% (grit-blasted-TiN), respectively. Both type of revision rates varied significantly between the uncemented groups (log-rank tests, P < .001, P < .001). All grit-blasted implants had a significantly higher risk of aseptic loosening (P < .01), and porous-uncoated implants had a significantly lower risk of aseptic loosening than cemented implants (P = .03) after 10 years. Conclusion: There were 4 main uncemented surface modifications identified, with different revision rates for aseptic loosening. Implants with porous-HA and porous-uncoated had the best revision rates, at least equal to cemented TKAs. Grit-blasted implants with and without TiN underperformed, possibly due to the interaction of other factors.",

keywords = "biological fixation, coating, register, surface modification, total knee arthroplasty, uncemented",

author = "Raymond Puijk and Rachid Rassir and Sierevelt, {Inger N.} and Anneke Spekenbrink-Spooren and Nelissen, {Rob G.H.H.} and Nolte, {Peter A.}",

note = "Funding Information: This research did not receive any grants or funding. None of the authors declare any competing interests. Ethical approval was not required for this study. Routinely collected data from the LROI were extracted for this study. Ethics approval and consent to participate were not applicable, as all data received was completely anonymous. Publisher Copyright: {\textcopyright} 2023 Elsevier Inc.",

year = "2023",

month = dec,

doi = "10.1016/j.arth.2023.05.094",

language = "English",

volume = "38",

pages = "2605--2611.e1",

journal = "Journal of Arthroplasty",

issn = "0883-5403",

publisher = "Churchill Livingstone",

number = "12",

}

TY - JOUR

T1 - Association Between Surface Modifications for Biologic Fixation and Aseptic Loosening of Uncemented Total Knee Arthroplasties

AU - Puijk, Raymond

AU - Rassir, Rachid

AU - Sierevelt, Inger N.

AU - Spekenbrink-Spooren, Anneke

AU - Nelissen, Rob G.H.H.

AU - Nolte, Peter A.

N1 - Funding Information: This research did not receive any grants or funding. None of the authors declare any competing interests. Ethical approval was not required for this study. Routinely collected data from the LROI were extracted for this study. Ethics approval and consent to participate were not applicable, as all data received was completely anonymous. Publisher Copyright: © 2023 Elsevier Inc.

PY - 2023/12

Y1 - 2023/12

N2 - Background: Various surface modifications are used in uncemented total knee arthroplasties (TKAs) to enhance bony ingrowth and longevity of implants. This study aimed to identify which surface modifications are used, whether they are associated with different revision rates for aseptic loosening, and which are underperforming compared to cemented implants. Methods: Data on all cemented and uncemented TKAs used between 2007 and 2021 were obtained from the Dutch Arthroplasty Register. Uncemented TKAs were divided into groups based on their surface modifications. Revision rates for aseptic loosening and major revisions were compared between groups. Kaplan-Meier, Competing-Risk, Log-rank tests, and Cox regression analyses were used. In total, 235,500 cemented and 10,749 uncemented primary TKAs were included. The different uncemented TKA groups included the following: 1,140 porous-hydroxyapatite (HA); 8,450 Porous-uncoated; 702 Grit-blasted-uncoated; and 172 Grit-blasted-Titanium-nitride (TiN) implants. Results: The 10-year revision rates for aseptic loosening and major revision of the cemented TKAs were 1.3 and 3.1%, and for uncemented TKAs 0.2 and 2.3% (porous-HA), 1.3 and 2.9% (porous-uncoated), 2.8 and 4.0% (grit-blasted-uncoated), and 7.9% and 17.4% (grit-blasted-TiN), respectively. Both type of revision rates varied significantly between the uncemented groups (log-rank tests, P < .001, P < .001). All grit-blasted implants had a significantly higher risk of aseptic loosening (P < .01), and porous-uncoated implants had a significantly lower risk of aseptic loosening than cemented implants (P = .03) after 10 years. Conclusion: There were 4 main uncemented surface modifications identified, with different revision rates for aseptic loosening. Implants with porous-HA and porous-uncoated had the best revision rates, at least equal to cemented TKAs. Grit-blasted implants with and without TiN underperformed, possibly due to the interaction of other factors.

AB - Background: Various surface modifications are used in uncemented total knee arthroplasties (TKAs) to enhance bony ingrowth and longevity of implants. This study aimed to identify which surface modifications are used, whether they are associated with different revision rates for aseptic loosening, and which are underperforming compared to cemented implants. Methods: Data on all cemented and uncemented TKAs used between 2007 and 2021 were obtained from the Dutch Arthroplasty Register. Uncemented TKAs were divided into groups based on their surface modifications. Revision rates for aseptic loosening and major revisions were compared between groups. Kaplan-Meier, Competing-Risk, Log-rank tests, and Cox regression analyses were used. In total, 235,500 cemented and 10,749 uncemented primary TKAs were included. The different uncemented TKA groups included the following: 1,140 porous-hydroxyapatite (HA); 8,450 Porous-uncoated; 702 Grit-blasted-uncoated; and 172 Grit-blasted-Titanium-nitride (TiN) implants. Results: The 10-year revision rates for aseptic loosening and major revision of the cemented TKAs were 1.3 and 3.1%, and for uncemented TKAs 0.2 and 2.3% (porous-HA), 1.3 and 2.9% (porous-uncoated), 2.8 and 4.0% (grit-blasted-uncoated), and 7.9% and 17.4% (grit-blasted-TiN), respectively. Both type of revision rates varied significantly between the uncemented groups (log-rank tests, P < .001, P < .001). All grit-blasted implants had a significantly higher risk of aseptic loosening (P < .01), and porous-uncoated implants had a significantly lower risk of aseptic loosening than cemented implants (P = .03) after 10 years. Conclusion: There were 4 main uncemented surface modifications identified, with different revision rates for aseptic loosening. Implants with porous-HA and porous-uncoated had the best revision rates, at least equal to cemented TKAs. Grit-blasted implants with and without TiN underperformed, possibly due to the interaction of other factors.

KW - biological fixation

KW - coating

KW - register

KW - surface modification

KW - total knee arthroplasty

KW - uncemented

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UR - http://www.scopus.com/inward/citedby.url?scp=85163820251&partnerID=8YFLogxK

U2 - 10.1016/j.arth.2023.05.094

DO - 10.1016/j.arth.2023.05.094

M3 - Article

C2 - 37295622

AN - SCOPUS:85163820251

SN - 0883-5403

VL - 38

SP - 2605-2611.e1

JO - Journal of Arthroplasty

JF - Journal of Arthroplasty

IS - 12

ER -

Association Between Surface Modifications for Biologic Fixation and Aseptic Loosening of Uncemented Total Knee Arthroplasties

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