A team of Australian researchers examining data from hundreds of thousands of primary total knee replacements (TKRs) has found that cross linked polyethylene (XLPE) stands out when it comes to reducing the risk of revision for infection.
Cross Linked Poly Reduces Infection Revision Risk
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The study,” The Effect of Alternative Bearing Surfaces on the Risk of Revision Due to Infection in Minimally Stabilized Total Knee Replacement: An Analysis of 326,603 Prostheses from the Australian Orthopaedic Association National Joint Replacement Registry” is published in the January 17, 2018 edition of The Journal of Bone & Joint Surgery.
Christopher J. Vertullo, MBBS, FRACS (Orth) with the Menzies Health Institute, Queensland, Griffith University in Australia and study co-author told OTW, “Infection following total knee replacement is a devastating complication as it often occurs early after implantation, involves two procedures to manage, and has a longer more expensive inpatient length of stay.”
“Moreover, the outcomes are typically worse than the primary TKR and it usually affects younger patients, increasing the disease burden. The infection rates after joint replacement have not decrease in recent decades despite increasing focus on the prevention of infection.”
“The study used the Australian Orthopaedic Association National Joint Replacement (AOANJRR) revision for infection data in a novel method, censoring the first six months to negate perioperative confounders such as surgeon and hospital. The AOANJRR has close to 100% national voluntary data compliance.”
“We found that cross linked polyethylene (XLPE) usage in minimally stabilized TKR, i.e., cruciate retaining or cruciate sacrificing, reduced the risk of revision for infection by 26%. This is the first paper linking infection risk in TKR with the type of bearing material used. This decreased risk with XLPE cannot be extrapolated to posterior stabilized TKR, where a post and cam replaces the posterior cruciate ligament.”
“Infection risk in arthroplasty is complex and multifactorial, with design and material factors playing a role in addition to patient factors and perioperative technique. Surgeons may wish to consider using cross linked polyethylene in TKR as it is associated with a lower risk of revision in cruciate retaining TKR.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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