SAINBIOSE INSERM Unit 1059, Mines de Saint Etienne, CHU de Saint Etienne, St Etienne Cedex 2, France; Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy.
Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy.
J Arthroplasty. 2018 Mar;33(3):908-914. doi: 10.1016/j.arth.2017.10.005. Epub 2017 Oct 10.
Reducing polyethylene (PE) wear by increasing the cross-linking encouraged surgeons to hope for increased total knee arthroplasty (TKA) survival rates. Different methods of manufacturing cross-linked polyethylene (XLPE) were introduced, following promising in vitro results. Is there a measurable effect of cross-linking on TKA survival?
A registry study was conducted, focusing on fixed tibial inserts in primary TKA. Conventional PE represented 87% of the liners, 10% were cross-linked and 2% were antioxidant PE. Sixty-four percent of the liners were posterior-stabilized (PS). Survival of the different PE groups and survival of the main XLPE available were successively compared. We also looked for differences in the same brand implant groups with regard to PE type, as well as differences between cruciate retaining and PS knees.
No differences were found when looking at survival for any cause or for aseptic loosening only (P = .96). When comparing the XLPE available, X3 was found to have a better survival than Prolong or Smith & Nephew XLPE (P = .036). When the same implants and X3 or conventional PE were used, no difference could reach a statistical significance. With Zimmer LPS Flex, Prolong XLPE was even associated with a lower survival compared with conventional PE. On Stryker implants, only the Cox regression model allowed highlighting a difference between X3 XLPE and conventional PE, only in PS knees.
Increasing the cross-linking seems to only have a low effect, if any, on knee arthroplasty survival. Differences between brands could be found; the manufacturing process could play a role.
通过增加交联来减少聚乙烯（PE）磨损，这促使外科医生希望提高全膝关节置换术（TKA）的生存率。不同的交联聚乙烯（XLPE）制造方法相继被引入，这些方法在体外取得了良好的效果。交联是否对 TKA 生存率有可衡量的影响？
进行了一项注册研究，重点关注初次 TKA 中的固定胫骨衬垫。传统的 PE 占衬垫的 87%，交联的占 10%，抗氧化的占 2%。64%的衬垫为后稳定型（PS）。依次比较了不同 PE 组的生存率和主要的 XLPE 生存率。我们还研究了同一品牌植入物组中 PE 类型的差异，以及交叉韧带保留和 PS 膝关节之间的差异。
当观察任何原因或无菌性松动的生存率时，没有发现差异（P=0.96）。比较可用的 XLPE 时，发现 X3 的生存率优于 Prolong 或 Smith & Nephew XLPE（P=0.036）。当使用相同的植入物和 X3 或传统 PE 时，没有差异达到统计学意义。在 Zimmer LPS Flex 中，与传统 PE 相比，Prolong XLPE 甚至与生存率降低相关。在 Stryker 植入物上，只有 Cox 回归模型能够突出 X3 XLPE 和传统 PE 之间的差异，仅在 PS 膝关节中。
增加交联似乎对膝关节置换术的生存率只有很小的影响，如果有的话。品牌之间可能存在差异；制造工艺可能会起作用。
