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Meta-Analysis
. 2022 Sep;30(9):3120-3130.
doi: 10.1007/s00167-022-06879-7. Epub 2022 Feb 19.

Comparable results between crosslinked polyethylene and conventional ultra-high molecular weight polyethylene implanted in total knee arthroplasty: systematic review and meta-analysis of randomised clinical trials

Alessandro Bistolfi  1 , Fortunato Giustra  2 , Francesco Bosco  3 , Carlotta Faccenda  2 , Marianna Viotto  2 , Luigi Sabatini  4 , Paola Berchialla  5 , Veronica Sciannameo  5 , Eugenio Graziano  1 , Alessandro Massè  2   4
Affiliations
Meta-Analysis

Comparable results between crosslinked polyethylene and conventional ultra-high molecular weight polyethylene implanted in total knee arthroplasty: systematic review and meta-analysis of randomised clinical trials

Alessandro Bistolfi et al. Knee Surg Sports Traumatol Arthrosc. 2022 Sep.

Abstract

Purpose: Total knee arthroplasty (TKA) has experienced exponential growth over the last decade, including increasingly younger patients with high functional demands. Highly crosslinked polyethylene (HXLPE) has been proven effective in reducing osteolysis and loosening revisions while improving long-term survival and performance in total hip arthroplasty; nevertheless, this superiority is not demonstrated in TKA. The aim of this systematic review and meta-analysis was to examine whether HXLPE improved overall survival and postoperative functional and radiological outcomes compared to conventional polyethylene (CPE) in TKA.

Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, a literature search of five databases (PubMed, Medline, Scopus, Science Direct and Embase) was made. A PICOS model was performed. The initial screening identified 2541 studies. Each eligible clinical article was analysed according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence (LoE). Only randomised clinical trials (RCTs) of LoE 1 and 2 were included. The methodological quality of the articles was assessed using the Risk of Bias 2 (RoB 2) tool.

Results: Six clinical studies were included in the final study. This systematic review and meta-analysis were registered on the International Prospective Register of Systematic Reviews (PROSPERO). A total of 2285 knees were included. Eight outcomes (total reoperations, reoperations for prosthesis loosening and infections, radiolucent lines, osteolysis, mechanical failure, postoperative KSS knee score and function score) were analysed. For none of them, a statistically significant difference was found about the superiority of HXLPE over CPE (p > 0.05).

Conclusions: There were no statistically significant differences between HXLPE and CPE for TKA concerning clinical, radiological, and functional outcomes; nevertheless, HXLPE did not show higher failure rates or complications and can be safely used for TKA.

Level of evidence: II.

Keywords: CPE; Crosslinked; Knee; Meta-analysis; Polyethylene; Total knee arthroplasty; UHMWPE.

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Conflict of interest statement

The authors have no conflict to declare. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of articles screened, selected, and included in the systematic review and meta-analysis
Fig. 2
Fig. 2
Risk of bias conformed by the Cochrane Handbook for Systematic Reviews of Interventions. The quality and risk of bias of individual randomised controlled trials included in the meta-analysis. D1 randomisation process, D2 Deviations from the intended interventions, D3 missing outcomes data, D4 measurement of the outcome, D5 Selection of the reported result, D6 overall
Fig. 3
Fig. 3
Total reoperations. HXLPE highly crosslinked polyethylene, CPE conventional polyethylene, IRR incidence rate ratio, CI confidence interval, p p value
Fig. 4
Fig. 4
Reoperations for prosthesis loosening. HXLPE highly crosslinked polyethylene, CPE conventional polyethylene, IRR incidence rate ratio, CI confidence interval, p p value
Fig. 5
Fig. 5
Reoperations for infections. HXLPE highly crosslinked polyethylene, CPE conventional polyethylene, IRR incidence rate ratio, CI confidence interval, p p value
Fig. 6
Fig. 6
Radiolucent lines. HXLPE highly crosslinked polyethylene, CPE conventional polyethylene, IRR incidence rate ratio, CI confidence interval, p p value
Fig. 7
Fig. 7
Osteolysis. HXLPE highly crosslinked polyethylene, CPE conventional polyethylene, IRR incidence rate ratio, CI confidence interval, p p value
Fig. 8
Fig. 8
Postoperative KSS knee score. KSS Knee Society Score, HXLPE highly crosslinked polyethylene, CPE Conventional Polyethylene, SMD standardised mean difference, CI confidence interval, p p value
Fig. 9
Fig. 9
Postoperative KSS function score. KSS Knee Society Score, HXLPE highly crosslinked polyethylene, CPE Conventional Polyethylene, SMD standardised mean difference, CI confidence interval, p p value
See this image and copyright information in PMC

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