• Users Online: 189
  • Print this page
  • Email this page


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 37  |  Issue : 3  |  Page : 129-140

A short-term study of clinical and radiological outcomes of total knee replacement using all polyethylene tibial component: A prospective observational study


Department of Orthopaedics, ABVIMS, Dr Ram Manohar Lohia Hospital, New Delhi, India

Date of Submission21-Sep-2022
Date of Acceptance24-Nov-2022
Date of Web Publication15-Dec-2022

Correspondence Address:
Sankalpa Jaiswal
Department of Orthopaedics, ABVIMS, Dr Ram Manohar Lohia Hospital, New Delhi 11001
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jbjd.jbjd_26_22

Rights and Permissions
  Abstract 

Osteoarthritis (OA) of bone peripherally is frequently associated with pain, physical disability and worsening quality of life, which in turn leads to a considerable burden on the society and individuals. The surgical management of OA comprises of arthroscopy, high tibial osteotomy (HTO), unicompartmental knee arthroplasty and total knee arthroplasty (TKA). High tibial osteotomy and unicompartmental knee arthroplasty are potential alternatives if only a single compartment is involved with more data supporting unicompartmental knee arthroplasty as a good treatment option in this scenario. To conclude, early tibial component designs were almost uniformly all polyethylene and still continue to dominate the market. The total condylar designs using these tibial components have continued to show greater than 90% survivorship. No statistically significant improvement was seen in the radiological outcomes in patients undergoing All-Polyethylene tibial component at short term follow up. In this study, there was a significant improvement in the Knee society score, WOMAC score and Oxford score post operatively.

Keywords: High tibial osteotomy, OA, OXFORD, total knee arthroplasty, uni-compartmental knee arthroplasty, WOMAC


How to cite this article:
Jaiswal S, Pandey SK, Yadav AK, Khare R, Singh D. A short-term study of clinical and radiological outcomes of total knee replacement using all polyethylene tibial component: A prospective observational study. J Bone Joint Dis 2022;37:129-40

How to cite this URL:
Jaiswal S, Pandey SK, Yadav AK, Khare R, Singh D. A short-term study of clinical and radiological outcomes of total knee replacement using all polyethylene tibial component: A prospective observational study. J Bone Joint Dis [serial online] 2022 [cited 2023 Feb 6];37:129-40. Available from: http://www.jbjd.in/text.asp?2022/37/3/129/363849




  Introduction and Background Top


Osteoarthritis (OA) of bone peripherally is frequently associated with pain, physical disability and worsening quality of life, which in turn leads to a considerable burden on the society and individuals. The incidence and prevalence of OA have increased over recent decades. Globally OA was ranked as 35th (66th) leading cause of total DALYs in women (men) in 2015. The aging population alongside the limited effect of treatments for OA, marked increases in overweight and obesity are possible explanations for this increasing OA burden. However, as a recent study noted by Wallace et al,[1] increases in longevity and obesity cannot fully explain recent increases in OA burden and recent environmental changes (e.g., physical inactivity and high intake of refined carbohydrates) might have played an important role. Moreover, the role of advances in diagnosis and medicalization should not be ruled out as more people are recognizing OA as a treatable condition, not just a given for getting old. The expected future increases in life expectancy and prevalence of overweight and obesity imply that the OA burden will continue to rise in the coming decades.[2] Osteoarthritis of the knee not only affects the quality of life of the individual physically but also emotionally and socially.[3] Most developed countries already have relatively high proportions (15–22%) of individuals aged ≥65 years, but the most rapid increases in the older population are in the developing world. India is the second most populous country in the world, with 1.21 billion people in its 2011 census. In 2011, the ≥60 years population accounted for 8% of the Indian population (93 million people). By the year 2050, the ≥60 years population will climb and account for 19% (323 million people) of the population. These trends will likely lead to increases in the burden of physical and cognitive disability, and osteoarthritis.[4] Management of OA includes Hyaluronic acid injections, platelet rich plasma, the use of mesenchymal stem cells which is emerging. The surgical management of OA comprises of arthroscopy, high tibial osteotomy, unicompartmental knee arthroplasty and total knee arthroplasty. High tibial osteotomy and unicompartmental knee arthroplasty are potential alternatives if only a single compartment is involved with more data supporting unicompartmental knee arthroplasty as a good treatment option in this scenario.[5]

In Orthopedic surgery, one of the procedures which are commonly performed is Total knee arthroplasty (TKA). It has a high success rate. There are various types of tibia components, which are used in TKR. These various materials include Cobalt-chromium Alloys, Titanium and Titanium Alloys, Polyethylene etc. The choice of a particular material often depends on various factors including perceived efficacy, longevity, cost, patient preferences and the experience of the treating surgeon with the material. But there is a strong need to make these decisions based on the published evidence, especially considering the midterm and long term results. In a typical knee replacement surgery, the tibial or patellar component is made of polyethylene material. In knee implants, the wear and tear are less common in comparison with the hip implants. Because in knee implants the bearing surfaces are flatter. Also in knee implants, novel materials such as “Ultra Highly Cross Linked Polyethylene (UHXLPE) or Ultra High Molecular Weight Polyethylene (UHMWPE)” when used further decrease the marginal wear thus extending the lifespan of these implants.

There are certain known benefits of All Polyethylene tibial components such as lesser price, good clinical outcome, lesser backside wear, long-standing survivorship, lesser associated complications such as avoidance of locking mechanism issues and no osteolysis, the amount of bone resection is same as used in metal component but polyethylene components have greater thickness is increased with Polyethylene and relative ease of isolated tibial component revision.[6] The disadvantages are lack of modularity limits intraoperative options, few options for cement less use, no options for linear removal in procedures involving acute irrigation or debridement, no options for late linear exchange, a potential difficulty with posterior extruded cement and increased shelf inventory.[6] In recent years, there has been a surge in the “All-polyethylene tibial (APT) total knee arthroplasty (TKA)”. Implant costs can decrease by 20–50% using APT components.[6],[7] On comparison with metal-backed tibial (MBT) components, they are also more durable. Even though there are many studies, which have proved the short term treatment outcomes of TKR with all polyethylene tibia components, there are only a very few studies documenting the mid and long term functional outcomes and radiological outcomes.

The need for our study arises because in India, there are only very few studies which have assessed the outcome of all polyethylene in total knee arthroplasty. Hence, this study was done to evaluate the outcome with all polyethylene tibial components in TKA.

Aim and objectives

  • Primary objective(s): To assess Short term clinical and radiological outcomes in patients undergoing All-Polyethylene tibial component Total Knee Arthroplasty.


  • A secondary objective(s): To identify the correlation of Oxford score, WOMAC scoring and Knee society score and knee Range Of Motion in patients undergoing Total Knee Arthroplasty.



  •   Materials and Methods Top


    Study site

    This study was conducted in the Department of Orthopaedics at JIPMER.

    Study population

    Patients with Osteoarthritis and Rheumatoid Arthritis coming to OPD in the Department of Orthopaedics at JIPMER were considered as the study population.

    Study design

    The current study was a Prospective observational study.

    Sample size

    Sample size was calculated assuming the mean Knee society score (Pre op) as 28.3 with a standard deviation of 10 and post op as 73.2 with a standard deviations of 22 As per the study by E. Vecchini et al.[8] The other parameters considered for sample size calculation were 90% power of study and 5% alpha error. The following formula was used for sample size calculation.



    N= Sample size

    µ1 – µ0=Difference between the means (28.3 and 73.2)

    σ1, σ0=Standard deviations (10 and 22)

    U=one-sided percentage point of the normal distribution corresponding to 100% – the power If the power is = 90%, u =1.28

    V=Percentage point of the normal distribution corresponding to the (two-sided) significance level for significance level = 5%, v = 1.96

    As per the above mentioned calculation, the required sample size was 6. To account for the non-participation rate of about 5%, another 1 subject will be added to the sample. Hence the final required sample size is 7 subjects on the whole.

    Sampling method

    All the eligible subjects were recruited into the study consecutively by convenient sampling until the sample size is reached.

    Study duration

    The data collection for the study was done between July 2016 to July 2018 for a period of 2 years.

    Inclusion criteria

  • All patients attending JIPMER OPD with grade 4 according to Kellgren and Lawrence classification knee osteoarthritis or rheumatoid requiring total knee arthroplasty.


  • Exclusion criteria

  • Patients are not giving consent.


  • A preexisting joint abnormality.


  • The patient expired due to an unrelated cause.


  • Ethical considerations

    Study was approved by the institutional human ethics committee. Informed written consent was obtained from all the study participants and only those participants willing to sign the informed consent were included in the study. The risks and benefits involved in the study and the voluntary nature of participation were explained to the participants before obtaining consent. Confidentiality of the study participants was maintained.

    Data collection tools

    All the relevant parameters were documented in a structured study proforma.

    Methodology

    All patients of knee osteoarthritis or rheumatoid arthritis with grade 4 according to Kellgren and Lawrence presenting to Orthopedic OPD in JIPMER and satisfying the Inclusion and Exclusion criteria were recruited in the study after obtaining informed consent. Basic investigation including radiograph of knee and routine lab investigations (CBC, ESR) was performed as a part of pre-operative workup. Pre-operative radiological and functional status of the patient was evaluated using The Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System, Oxford scoring system whereas pain was assessed by WOMAC scoring system. Recruited patients will undergo TKA using all polyethylene tibial component. Post operatively, the patient was assessed by The Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System, Oxford knee score and WOMAC knee score which was repeated at the end of 6 months. Any difference between preoperative and postoperative scores was calculated and was compared with historical control of TKA with Metal backed tibial component for statistical significance.

    • A)Data collection methods
      • a)Oxford Knee scoring


      • b)Duration of surgery


      • c)Pain


      • d)Knee society score


      • e)WOMAC scoring


    • B)periodicity: from the start of study till 6 months post-surgery [Figure 1].
      Figure 1: Study procedure

      Click here to view




    Statistical methods

    Oxford Knee score, Knee society score, radiological outcomes, WOMAC score were considered as outcome variables. “Age, Gender, Occupation, socioeconomic status were other variables. Descriptive analysis was carried out by the mean and standard deviation for quantitative variables, frequency and proportion for categorical variables. Non-normally distributed quantitative variables were summarized by median and interquartile range (IQR)”. Data was also represented using appropriate diagrams like a bar diagram, pie diagram and box plots. The change in the quantitative parameters, before and after the intervention was assessed by paired t-test (In the case of two time periods). P value <0.05 was considered statistically significant. IBM PASW Statistics (SPSS) version 19.0 (2010).


      Results Top


    A total of 7 people was included in the final analysis.

    The mean age was 61.14 ± 4.810. The minimum age was 55 and the maximum age was 68 in the study population. (95% CI 56.69 to 65.59) [Table 1].
    Table 1: Descriptive analysis for age in the study population (n = 7)

    Click here to view


    Among the study population 2(28.57%) participants were male and remaining 5(71.43%) participants were female [Table 2] and [Figure 2].
    Table 2: Descriptive analysis of gender in the study population (n = 7)

    Click here to view
    Figure 2: Bar graph for gender distribution in the study population (n = 7)

    Click here to view


    Among the study population 5(71.43%) were house wives and the remaining 2(28.57%) were a manual laborer [Table 3] and [Figure 3].
    Table 3: Descriptive analysis of occupation in the study population (n = 7)

    Click here to view
    Figure 3: Pie graph for occupation distribution in the study population (n = 7)

    Click here to view


    Among the study population 2(28.57%) belonged to upper middle socioeconomic status, 3(42.86%) belonged to lower class and remaining 2(28.57%) belonged to upper lower socio economic status [Table 4] and [Figure 4].
    Table 4: Descriptive analysis of socio-economic status in the study population (n = 7)

    Click here to view
    Figure 4: Bar graph for socio-economic status distribution in the study population (n = 7)

    Click here to view


    Among the study population 4(57.14%) had right side involved and remaining 3(42.86%) had left side involved [Table 5] and [Figure 5].
    Table 5: Descriptive analysis of side in the study population (n = 7)

    Click here to view
    Figure 5: Pie graph for side distribution in the study population (n = 7)

    Click here to view


    Among the study population 1(14.29%) had pre op Knee ROM 0–50, 2(28.57%) had 0–60, 1(14.29%) had 0–70, 1(14.29%) had 0–80 and remaining 2(28.57%) had 0–90. Among the study population 1(14.39%) had 0–100 post op ROM, 2(28.57%) had 1–110, 2(28.57%) had 0–120, 1(14.29%) had 0–130 and 1(14.29%) had 0–90 [Table 6].
    Table 6: Descriptive analysis of pre-op knee rom, post op knee rom in the study population (n = 7)

    Click here to view


    The mean Knee society score pre op score was 32.85 ± 3.132. Minimum score was 29 and maximum was 37 in the study population. The mean Knee society score post op score was 75.28 ± 17.54. Minimum score was 36 and the maximum was 87 in the study population [Table 7].
    Table 7: Descriptive analysis for knee society score (pre op), knee society score (post op) in the study population (n = 7)

    Click here to view


    The mean duration of surgery was 2.214 ± 0.267. Minimum duration was 2 hours and maximum duration was 2.50 hours in the study population [Table 8].
    Table 8: Descriptive analysis for duration of surgery (Hrs) in the study population (n = 7)

    Click here to view


    The mean WOMAC score pre op was 76.57 ± 5.126. The minimum percentage was 66, and the maximum percentage was 82 in the study population. The mean WOMAC score pre-op was 28 ± 13.82. The minimum percentage was 20, and the maximum percentage was 59 in the study population [Table 9].
    Table 9: Descriptive analysis for womac score pre op%, womac score post op% in the study population (n = 7)

    Click here to view


    The mean femoral flexion pre op was 15.57 ± 1.511. Minimum score was 14 and the maximum was 18 in the study population. The mean femoral flexion post op was 14.57 ± 2.070. Minimum score was 12 and the maximum was 18 in the study population [Table 10].
    Table 10: Descriptive analysis for femoral flexion (pre op - LAT), femoral flexion (Postop - LAT) in the study population (n = 7)

    Click here to view


    The mean femoral flexion preop-AP was 93.71 ± 6.575. Minimum score was 85 and the maximum was 102 in the study population. The mean femoral flexion post op-AP was 93.71 ± 6.575. Minimum score was 84 and the maximum was 98 in the study population [Table 11].
    Table 11: Descriptive analysis for femoral flexion (PRE OP - AP), femoral flexion (POSTOP – AP) in the study population (n = 7)

    Click here to view


    The mean Tibial angle pre op-LAT was 90.71 ± 5.707. Minimum was 81 and the maximum was 96 in the study population. The mean Tibial angle post op-LAT was 91.85 ± 6.067. Minimum was 84 and the maximum was 100 in the study population [Table 12].
    Table 12: Descriptive analysis for tibial angle (Pre Op - LAT), tibial angle (Post Op - LAT) in the study population (n = 7)

    Click here to view


    The mean Tibial angle pre op-AP was 90.28 ± 7.674. Minimum was 82 and the maximum was 100 in the study population. The mean Tibial angle post op-AP was 89 ± 3.366. Minimum was 89 and the maximum was 85 in the study population [Table 13].
    Table 13: Descriptive analysis for Tibial Angle (Pre Op - Ap), Tibial Angle (Post Op - Ap) in the study population (n = 7)

    Click here to view


    The mean total Valgus angle pre op-AP was 184 ± 2.828. Minimum score was 180 and the maximum score was 189 in the study population. The mean total Valgus angle post op –AP was 180.7 ± 3.147. The mnimum score was 176 and the maximum score was 184 in the study population [Table 14].
    Table 14: Descriptive analysis for total valgus angle (pre op - ap), total valgus angle (post op - ap), in the study population (n = 7)

    Click here to view


    The mean total Valgus angle pre op was 105.5 ± 5.349. The mnimum score was 98 and the maximum score was 114 in the study population. The mean total Valgus angle post op was 106.8 ± 5.843. The mnimum score was 100 and the maximum score was 118 in the study population [Table 15].
    Table 15: Descriptive analysis for total valgus angle (Pre Op - LAT), total valgus angle (Post Op - LAT) in the study population (n = 7)

    Click here to view


    The mean Oxford Knee score pre op was 78.42 ± 1.902. Minimum score was 77 and the maximum was 81 in the study population. The mean Oxford Knee score post op was 20 ± 20.33. Minimum score was 10 and the maximum was 66 in the study population [Table 16].
    Table 16: Descriptive analysis for oxford knee score pre op, oxford knee score post op in the study population (n = 7)

    Click here to view


    The mean Pain pre-op was 3 ± 0. Minimum score was 3 and the maximum score was 3 in the study population. The mean Pain post op was 1.285 ± 0.755. Minimum score was 1 and the maximum score was 3 in the study population [Table 17].
    Table 17: Descriptive analysis for pain (PRE OP), pain (POSTOP), BMI in the study population (n = 7)

    Click here to view


    The mean of Knee society score pre op was 32.86 ± 3.13, it was 75.29 ± 17.55 for post op. The mean of WOMAC score pre op was 76.57 ± 5.13, it was 28 ± 13.82 for post op. The mean of OXFORD score pre op was 78.43 ± 1.9, it was 20 ± 20.33 for post op. The mean of Pain score pre op was 3 ± 0, it was 1.29 ± 0.76 for post op. The difference in the proportion of Knee society score, WOMAC score, Oxford score, and pain score between pre op and post op was statistically significant. (P value <0.05) [Table 18] and [Figure 6].
    Table 18: Comparison of mean different scores pre op and post op in the study population (n = 7)

    Click here to view
    Figure 6: Cluster bar graph for comparison of the mean of different scores pre op and post op in the study population (n = 7)

    Click here to view


    The mean of Tibial angle-AP pre op was 90.29 ± 7.68, it was 89 ± 3.37 for post op. The mean of Total Valgus angle AP pre op was 184 ± 2.83, it was 180.71 ± 3.15 for post op. The mean of Femoral Flexion AP pre op was 93.71 ± 6.58, it was 91.57 ± 6 for post op. The mean of Tibial angle-LAT pre op was 90.71 ± 5.71, it was 91.86 ± 6.07 for post op. The mean of Total Valgus angle LAT pre op was 105.57 ± 5.35, it was 106.86 ± 5.84 for post op. The mean of Femoral Flexion LAT pre op was 15.57 ± 1.51, it was 14.57 ± 2.07 for post op. The difference in the proportion of all angles between pre op and post op was statistically not significant (P value >0.05) [Table 19] and [Figure 7].
    Table 19: Comparison of the mean of different angles pre op and post op in the study population (n = 7)

    Click here to view
    Figure 7: Cluster bar graph for comparison of the mean of different angles pre op and post op in the study population

    Click here to view



      Discussion Top


    Total knee replacement surgery is aimed at reduction of pain, improvement in range of motion and quality of life. Patient satisfaction is highly dependent on these factors. Recent advancement and modifications in TKA have provided excellent outcomes. Compared to the metal-backed components, All-poly tibial components have been reported to reduce the cost of TKR procedure by 24%-48% without compromising on the performance. Improvement in range of motion and pain relief are the two most important measures of a successful total knee replacement.[9],[10] Types of TKR presently in use have Metal backed and all Polyethylene. In developing countries economic background of patients requiring TKR also has to be kept in mind, hence increased durability of implants, cost reduction is the need of the hour. Metal backed components as compared to all Polyethylene are higher in costs, have locking mechanism issues, backside wear, higher prevalence of osteolysis. All polyethylene tibial component was introduced with purported advantages of increased durability, ease of surgery as well as decreased cost.[6] The design of all-polyethylene tibial components preceded monoblock or modular metal-backed tibial components by several years. But then metal-backed tibial components gained popularity over the years and were used in the majority of TKAs. The all-polyethylene tibial component used in primary TKAs has again regained interest in the recent past especially in developing countries because of cost saving. So, in a developing country like India, this current study assessed short term clinical and radiological outcomes in patients undergoing all-polyethylene tibial component total knee arthroplasty. A total of 15 subjects gave consent for all poly TKR implants in OPD but during preoperative counselling 8 subjects declined all poly and preferred conventional tibial metal backed implants. 8 patients have declined the consent because they thought that decreased costs could compromise implant quality. Hence, in the end, only a total of 7 subjects were included in the final analysis. Patient perception of the outcome after total knee replacement is a topic of much needed research.[14] Major apprehensions felt by patients included the level of ambulation, dependency and post-surgical complications.[14],[15] There are also apprehensions on the quality and durability of the prosthesis.[16]

    In the current study, the mean age was 61.14 ± 4.810. The minimum age was 55 and the maximum age was 68 in the study population. 2(28.57%) participants were male and remaining 5(71.43%) participants were females. Our study findings were similar to the study by Lakkireddy M. et al[17] where the age group of the cohort was 60 ± 11.2 years and 141 were females (173 knees), and 79 were males (88 knees). The mean age was 67.67 ± 7.87 in the study by Singh A et al[10] and the group comprised of 43% men and 57% women. In the study sixth Hussain NAR et al[18] the mean age was 67 years. 45% were males, and 65% were females. Similarly, in the study by Chandran R et al.,[19] the majority of the patients were from the age group of 70–74 years which accounted for 40% of patients in the study. The majority of the patients in the study by Hussain NAR et al[18] were from the age group 60–65 years accounting for about 40% of the patients with the mean age of 67 years. The majority of the participants were females (60%). It confirms the fact that the most vulnerable age group for severe knee osteoarthritis is the sixth and seventh decade of life. The female predominance was seen in almost all the studies attributing to the fact that female gender was more commonly affected by knee osteoarthritis.

    In the current study, the majority of the participants 4(57.14%) underwent right side TKA, and the remaining 3(42.86%) had left side involved. The study by Hussain NAR et al[18] reported that right side was operated more commonly than left (Left side 18 (30%, right side 42 (70%) which was in accordance to the current study. Giesinger JM et al[12] in their study reported that right side 53.0% was more involved than the left side 47.0%. However, Singh A et al[10] 54% left side involvement and 46% right side involvement which is contradictory to our study.

    The mean of Knee society score pre op was 32.86 ± 3.13, it was 75.29 ± 17.55 for post op. Dojcinovic et al[11] reported that Knee society score improved from 32 to 81 in all poly total knee replacement. Giesinger, J. M., et al.[12] reported the Knee society score improved from 46.4 (22.7) to 70.1 (29.3) in 12 months follow up [Table 20].
    Table 20: Comparison of baseline parameters and outcome scores between the studies

    Click here to view


    The mean of WOMAC score pre op was 76.57 ± 5.13, it was 28 ± 13.82 for post op. Giesinger, J. M., et al.[12] reported the improvement from score 24.1 (17.3) post op to 13.6 (16.5) post op. Patel, KR et al[20] in his study reported that WOMAC scores improved from 54.07 to 82.39 with a minimum pre-operative score of 19 and maximum of 74 and a postoperative score ranging from 29 to 93 which is similar to our study.

    The mean of Pain score pre op was 3 ± 0, it was 1.29 ± 0.76 for post op. in the study by Singh, A[10] the pain score decreased from 3.2 ± 0.57 (Range 2–4) to 1.02 ± 0.75 (Range 0–2) during short term follow up. The mean of OXFORD score pre op was 78.43 ± 1.9, it was 20 ± 20.33 for post op. Kim, K. T., et al[13] in their study found that the Oxford knee score was decreased from 42.9 preoperatively to 23.1 at the last follow-up.

    Among the study population 1(14.29%) had pre op Knee ROM 0–50, 2(28.57%) had 0–60, 1(14.29%) had 0–70, 1(14.29%) had 0–80 and remaining 2(28.57%) had 0–90. Among the study population 1(14.39%) had 0–100 post op ROM, 2(28.57%) had 1–110, 8(53.33%) had 0-120 0-120, 1(14.29%) had 0–130 and 1(14.29%) had 0–90. Our study findings were similar to the study by Kim, K. T., et al[13] where the mean range of motion was improved from 107.9°±17.4° (range, 70° to 135°) preoperatively to 125.2°±10.5° (range, 90° to 135°) at the last follow-up (P < 0.001). Singh, A[10] reported improved range of motion significantly from preoperative 104°±5.67° (range, 85°-119°) to 119.8°±11.05° (98°-123°) at follow-up (P < 0.05).

    The mean of Tibial angle-AP pre op was 90.29 ± 7.68, it was 89 ± 3.37 for post op. The mean of Total Valgus angle AP pre op was 184 ± 2.83, it was 180.71 ± 3.15 for post op. The mean of Femoral Flexion AP pre op was 93.71 ± 6.58, it was 90.33 ± 5.83 for post op. The mean of Tibial angle-LAT pre op was 90.71 ± 5.71, it was 91.86 ± 6.07 for post op. The mean of Total Valgus angle LAT pre op was 105.57 ± 5.35, it was 106.86 ± 5.84for post op. The mean of Femoral Flexion LAT pre op was 15.57 ± 1.51, it was 14.57 ± 2.07 for post op. The difference in the proportion of Tibial angle-LAT, Total Valgus angle LAT between pre op and post op was statistically significant (P value <0.05). The difference in the proportion of remaining angles between pre op and post op was statistically not significant. There were no studies that reported these exact parameters at short term follow-up. Kim, K. T., et al[13] reported the mean flexion contracture was 6.4°±6.8° (range, 0° to 30°) preoperatively and 2.5°±4.1° (range, 0° to 20°) at the last follow-up (P < 0.001). The mean femorotibial angle was improved from 10.13°±4.92° Varus (range, -25° to +2°) preoperatively to 3.31°±4.51° valgus (range, -4° to +5°) at the last follow-up (P < 0.001). Our study did not notice these changes in the short term follow up. This was only an observational study; thus, the observed association cannot be interpreted as causal inferences. The sample size was too small. Hence the study cannot be generalized to the rest of the population. Follow up was only for a period of 6 months hence TKR longevity could not be assessed.

    The advantages of All Polyethylene tibial components are lower cost, excellent clinical results, long term survivorship, avoidance of locking mechanism issues and backside wear, osteolysis rarely reported, increased polyethylene thickness with the same amount of bone resection as used for same size metal backed component and relative ease of isolated tibial component revision.[6] Implant cost per total knee replacement procedure accounts for approximately 50% of the total cost.[21] It’s also seen that the Monoblock all-polyethylene tibial component has a lesser risk of early revision than metal-backed modular components.[22] The APT designs have shown long-term survivorship of up to 90%. Ten-year survivorship of the all-polyethylene tibial component was 91.6% with revision for any reason and 100% for aseptic loosening. The metal backed tibial component survival was seen up to 88.9% with revision for any reason and 94.3% for aseptic loosening. The contemporary all-polyethylene tibial component functioned equivalently to its monoblock counterpart and was less costly.[23]

    The all-polyethylene tibial components are known to be more cost-efficient with less failure of the locking mechanism and the backside wear. Moreover, it has thicker polyethylene with decreased bone resection, i.e., the higher yield strength of the polyethylene.[6] In the case of metal-backed tibial components, they have certain advantages in terms of intraoperative flexibility wherein cement less application is feasible and late liner exchange can be done in case of wear.[6]

    But some of the disadvantages of all-polyethylene tibial components include lack of modularity limits intraoperative options, few options for cement less use, no options for linear removal in procedures involving acute irrigation or debridement, no options for late linear exchange, a potential difficulty with posterior extruded cement and increased shelf inventory.[6] All-polyethylene tibial (APT) total knee arthroplasty (TKA) has gained renewed interest in recent years. An important concern is the combination of durability with cost reduction compared with metal-backed tibial (MBT) components. Implant costs can decrease by 20–50% using APT components.[6],[7]

    Further long term studies, with randomization, would shed better information about the results of all poly TKR. The “stigma” associated with knee prosthesis also needs future patient outcome based studies.

    Limitations

    1. This was an observational study; thus, the observed association cannot be interpreted as causal inferences.


    2. The sample size was too small and is one of the major limitations of the study. Hence the study cannot be generalized to the rest of the population.


    3. Purposive sampling technique was employed for the study which is not a true representation of the general population.



      Conclusion Top


    Early tibial component designs were almost uniformly all polyethylene and still continue to dominate the market. The total condylar designs using these tibial components have continued to show greater than 90% survivorship.[24] No statistically significant improvement was seen in the radiological outcomes in patients undergoing All-Polyethylene tibial component at short term follow up. In this study, there was a significant improvement in the Knee society score, WOMAC score and Oxford score post operatively.


      Summary Top


  • Patients’ perception plays a strong role in is a selection of prosthesis.


  • A total of 7 people were included in the final analysis. The mean age was 61.14 ± 4.810. The minimum age was 55 years and the maximum age was 68 in the study population. (95% CI 56.69 to 65.59).


  • Majority of the study participants were females 5 (71.43%).


  • Among the study population 5(71.43%) were house wives, 2(28.57%) were a manual laborer. 2(28.57%) belonged to upper middle socioeconomic status, 3(42.86%) belonged to lower class and remaining 2(28.57%) belonged to upper lower socioeconomic status.4(57.14%) had right side involved and remaining 3(42.86%) had left side involved.


  • Among the study population 1(14.29%) had pre op Knee ROM 0–50, 228.57%) had 0–60, 1(14.29%) had 0–70, 1(14.29%) had 0–80 and remaining 2(28.57%) had 0–90. Among the study population 1(14.39%) had 0–100 post op ROM, 2(28.57%) had 1–110, 2(28.57%) had OXFORD.


  • The mean of Knee society score pre op was 32.85 ± 3.132, it was 75.28 ± 17.54 for post op. The mean of WOMAC score pre op was 76.57 ± 5.12, it was 28 ± 13.82 for post op. The mean of OXFORD score pre op was 78.42 ± 1.902, it was 20 ± 20.33 for post op. The difference in the proportion of Knee society score, WOMAC score, Oxford score, between pre op and post op was statistically significant. (P value <0.05).


  • The mean of Tibial angle-AP pre op was 89.67 ± 8.47, it was 90.07 ± 3.6 for post op. The mean of Total Valgus angle AP pre op was 182.4 ± 5.84, it was 180.47 ± 3.04 for post op. The mean of Femoral Flexion AP pre op was 92.73 ± 6.95, it was 90.33 ± 5.83 for post op. The mean of Tibial angle-LAT pre op was 86.07 ± 8.28, it was 90.47 ± 4.5 for post op. The mean of Total Valgus angle LAT pre op was 100 ± 8.89, it was 104.53 ± 4.69for post op. The mean of Femoral Flexion LAT pre op was 14.27 ± 1.91, it was 13.87 ± 1.96 for post op. The difference in the proportion of all angles between pre op and post op was statistically not significant (P value >0.05).


  • Financial support and sponsorship

    This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

    Conflicts of interest

    There are no conflicts of interest.



     
      References Top

    1.
    Wallace IJ, Worthington S, Felson DT, Jurmain RD, Wren KT, Maijanen H, et al. Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proc Natl Acad Sci U S A 2017;114:9332-6.  Back to cited text no. 1
        
    2.
    Kiadaliri AA, Lohmander LS, Moradi-Lakeh M, Petersson IF, Englund M High and rising burden of hip and knee osteoarthritis in the nordic region, 1990-2015. Acta Orthop 2018;89:177-83.  Back to cited text no. 2
        
    3.
    Palo N, Chandel SS, Dash SK, Arora G, Kumar M, Biswal MR Effects of osteoarthritis on quality of life in elderly population of Bhubaneswar, India: A prospective multicenter screening and therapeutic study of 2854 patients. Geriatr Orthop Surg Rehabil 2015;6:269-75.  Back to cited text no. 3
        
    4.
    Singh T, Sharma PK, Jammy GR, Cauley JA, Bunker CH, Reddy PS, et al. Design of the mobility and independent living in elders study: An older adult cohort in rural india. Geriatr Gerontol Int 2017;17:31-40.  Back to cited text no. 4
        
    5.
    Fibel KH, Hillstrom HJ, Halpern BC State-of-the-art management of knee osteoarthritis. World J Clin Cases 2015;3:89-101.  Back to cited text no. 5
        
    6.
    Gioe TJ, Maheshwari AV The all-polyethylene tibial component in primary total knee arthroplasty. J Bone Joint Surg Am 2010;92:478-87.  Back to cited text no. 6
        
    7.
    Nouta KA, Pijls BG, Nelissen RG All-polyethylene tibial components in Tka in rheumatoid arthritis: A 25-year follow-up study. Int Orthop 2012;36:565-70.  Back to cited text no. 7
        
    8.
    Vecchini E, Christodoulidis A, Magnan B, Ricci M, Regis D, Bartolozzi P Clinical and radiologic outcomes of total knee arthroplasty using the advance medial pivot prosthesis. A mean 7 years follow-up. Knee 2012;19:851-5.  Back to cited text no. 8
        
    9.
    Browne JA, Gall Sims SE, Giuseffi SA, Trousdale RT All-polyethylene tibial components in modern total knee arthroplasty. J Am Acad Orthop Surg 2011;19:527-35.  Back to cited text no. 9
        
    10.
    Singh A, Singh KK Clinical evaluation of efficacy and performance of all-poly tibial freedom® total knee system for treating osteoarthritis patients: Three-year follow up study. J Clin Diagn Res 2017;11:RC01-5.  Back to cited text no. 10
        
    11.
    Dojcinovic S, Ait Si Selmi T, Servien E, Verdonk PC, Neyret P Comparaison entre embase tibiale métallique et plateau tout polyéthylène dans la prothèse totale de genou. Rev Chir Orthop Repar Appar Mot 2007;93:364-72.  Back to cited text no. 11
        
    12.
    Giesinger JM, Hamilton DF, Jost B, Behrend H, Giesinger K Womac, Eq-5d and knee society score thresholds for treatment success after total knee arthroplasty. J Arthroplasty 2015;30:2154-8.  Back to cited text no. 12
        
    13.
    Kim KT, Kang MS, Lim YH, Park JW, Wang L Short-term results of total knee arthroplasty with anterior-posterior glide Lcs mobile-bearing system. Knee Surg Relat Res 2014;26:162-7.  Back to cited text no. 13
        
    14.
    Boniforti F, Macaione A, Gagliardi S, Giangrasso F, DI Marzo D, Giacco F Early assessment of patient perception of outcome in total knee replacement. Joints 2014;2:71-5.  Back to cited text no. 14
        
    15.
    Baker PN, Rushton S, Jameson SS, Reed M, Gregg P, Deehan DJ Patient satisfaction with total knee replacement cannot be predicted from pre-operative variables alone: A cohort study from the national joint registry for england and wales. Bone Joint J 2013;95-B:1359-65.  Back to cited text no. 15
        
    16.
    Cheung KW, Chung SL, Chung KY, Chiu KH Patient perception and knowledge on total joint replacement surgery. Hong Kong Med J 2013;19:33-7.  Back to cited text no. 16
        
    17.
    Lakkireddy M Analysis of total knee replacements in a South Indian Institute. Int J Res Orthop 2018;4:187-92.  Back to cited text no. 17
        
    18.
    Naushad Hussain A, Kami P, Kumar S A retrospective analysis of patients undergoing total knee replacement using knee society score. J Cont Med Dent 2017;5:42-4.  Back to cited text no. 18
        
    19.
    Chandran R, Shetty SK, Shetty A, Balan B, Lawrence J, Mathias LJ A study of functional outcome after Primary Total Knee Arthroplasty in elderly patients. IAIM 2016;3:297-301.  Back to cited text no. 19
        
    20.
    Patel KR, Patel HR, Patel ZM, Mehta KA Mid-term results of all poly total knee replacement versus metal-back total knee replacement. Int J Orthop Rheumatol 2016;2:9-12.  Back to cited text no. 20
        
    21.
    Kurtz S, Ong K, Lau E, Mowat F, Halpern M Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007;89: 780-5.  Back to cited text no. 21
        
    22.
    Mohan V, Inacio MC, Namba RS, Sheth D, Paxton EW Monoblock all-polyethylene tibial components have a lower risk of early revision than metal-backed modular components. Acta Orthop 2013;84:530-6.  Back to cited text no. 22
        
    23.
    Gioe TJ, Stroemer ES, Santos ER All-polyethylene and metal-backed tibias have similar outcomes at 10 years: A randomized level I [corrected] evidence study. Clin Orthop Relat Res 2007; 455:212-8.  Back to cited text no. 23
        
    24.
    Gioe TJ, Sinner P, Mehle S, Ma W, Killeen KK Excellent survival of all-polyethylene tibial components in a community joint registry. Clin Orthop Relat Res 2007;464:88-92.  Back to cited text no. 24
        


        Figures

      [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
     
     
        Tables

      [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14], [Table 15], [Table 16], [Table 17], [Table 18], [Table 19], [Table 20]



     

    Top
     
     
      Search
     
    Similar in PUBMED
       Search Pubmed for
       Search in Google Scholar for
     Related articles
    Access Statistics
    Email Alert *
    Add to My List *
    * Registration required (free)

     
      In this article
    Abstract
    Introduction and...
    Materials and Me...
    Results
    Discussion
    Conclusion
    Summary
    References
    Article Figures
    Article Tables

     Article Access Statistics
        Viewed148    
        Printed10    
        Emailed0    
        PDF Downloaded25    
        Comments [Add]    

    Recommend this journal


    [TAG2]
    [TAG3]
    [TAG4]