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. 2024 Sep 5;11(3):e12106.
doi: 10.1002/jeo2.12106. eCollection 2024 Jul.

Vitamin E-stabilized polyethylene shows similar survival rates at minimum 7-year follow-up compared to conventional polyethylene in primary total knee arthroplasty

Alessandro Bistolfi  1 , Marco Spezia  2 , Alessandra Cipolla  3 , Monica Bonera  3 , Danilo Mellano  2 , Lorenzo Banci  4 , Marta Colombo  4 , Alessandro Massè  3   5
Affiliations

Vitamin E-stabilized polyethylene shows similar survival rates at minimum 7-year follow-up compared to conventional polyethylene in primary total knee arthroplasty

Alessandro Bistolfi et al. J Exp Orthop. .

Abstract

Purpose: The aim of this cross-sectional study was to compare survival, clinical and radiographic results of total knee arthroplasty (TKA) with vitamin E-stabilized polyethylene (VEPE) or conventional polyethylene (CPE) at a minimum of 7-year follow-up.

Methods: Patients who underwent primary TKA between 2011 and 2015, receiving the same cemented rotating platform knee design with VEPE or CPE tibial inserts, were identified. Patients were contacted for clinical and radiographic follow-up. American Knee Society Score (KSS), Forgotten Joint Score (FJS-12), presence of periprosthetic radiolucent lines (RLLs) and osteolysis were evaluated at the last follow-up. Any revision, reintervention or other complications were recorded.

Results: Among 350 TKAs initially identified, 102 VEPE and 97 CPE knees were included for analysis with mean follow-up of 8.5 and 8.3 years, respectively. No significant difference was found in survival rates at 10-year follow-up with revision due to aseptic loosening (95.0% vs. 97.8%, p = 0.29) or due to any reason (87.6% vs. 89.6%, p = 0.78) between VEPE and CPE TKA. KSS function score resulted significantly higher in the VEPE group over CPE (77 vs. 63, p = 0.01). RLLs were more frequent in VEPE than CPE (54% vs. 32%, p = 0.05), mainly noticed medially and posteriorly beneath the tibial plate, adjacent to the trochlear shield and the posterior condyles. Osteolysis was observed in one knee per group, but patients were asymptomatic with stable implants.

Conclusion: TKA with VEPE and CPE tibial inserts showed comparable survival rates, complications and clinical and radiographic results up to 10-year follow-up.

Level of evidence: Level III.

Keywords: UHMWPE; conventional polyethylene; total knee arthroplasty; vitamin E; vitamin E‐stabilized.

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Conflict of interest statement

Lorenzo Banci and Marta Colombo are employed as clinical researchers at Permedica Orthopaedics. Marco Spezia is a paid consultant and received research support from Permedica Orthopaedics. The other authors have no relevant financial or non‐financial interests related to the present study to disclose.

Figures

Figure 1
Figure 1
Vitamin E‐blended ethylene oxide sterilized polyethylene (a) and conventional polyethylene (b) ultra‐congruent rotating tibial inserts implanted with the same cemented rotating platform titanium‐niobium nitride coated bicompartmental knee prosthesis in all investigated knees.
Figure 2
Figure 2
Study flowchart. Out of the 350 eligible TKAs initially identified, 79 VEPE and 72 CPE knees were found lost to follow‐up and were excluded from the study. Analysis regarded the remaining 102 VEPE and 97 CPE knees. CPE, conventional polyethylene; FU, follow‐up; TKA, total knee arthroplasty; VEPE, vitamin E‐stabilized polyethylene.
Figure 3
Figure 3
Survival rates with revision for aseptic loosening as the end point for VEPE versus CPE groups. Dotted lines are 95% confidence intervals. CPE, conventional polyethylene; VEPE, vitamin E‐stabilized polyethylene.
Figure 4
Figure 4
Survival rates with revision for any reason as the end point for VEPE versus CPE groups. Dotted lines are 95% confidence intervals. CPE, conventional polyethylene; VEPE, vitamin E‐stabilized polyethylene.
Figure 5
Figure 5
Anterior‐posterior (a) and lateral (b) radiographs of the knee taken at 10‐year follow‐up showing periprosthetic radiolucent lines (white arrowheads) around knee implant with VEPE tibial insert. VEPE, vitamin E‐stabilized polyethylene.
Figure 6
Figure 6
Anterior‐posterior and lateral radiographs of the knee taken immediately postoperatively ((a) and (b), respectively) and at 8‐year follow‐up ((c) and (d), respectively) showing periprosthetic osteolysis (white arrowheads) around knee implant with VEPE tibial insert. VEPE, vitamin E‐stabilized polyethylene.
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