Antioxidant-Loaded Highly Cross-Linked Polyethylene May Reduce Revision Risk in Total Knee Arthroplasty: A U.S.-Based...

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Clinical Epidemiology

Background:

• The use of highly cross-linked polyethylene (HXLPE) in total knee arthroplasty (TKA) is increasing.
• Evidence comparing HXLPE with and without antioxidants for TKA survivorship is limited.
• This study addresses the need to compare revision risks between these two types of HXLPE implants.

Purpose of the Study:

• To compare the risk of revision surgery for total knee arthroplasty (TKA) using highly cross-linked polyethylene (HXLPE) with and without added antioxidants.
• To evaluate the impact of antioxidants in HXLPE on TKA survivorship and identify specific reasons for revision.

Main Methods:

• A cohort study utilizing data from the Kaiser Permanente total joint replacement registry.
• Inclusion of adult patients who underwent primary fixed-bearing TKA with patellar resurfacing for osteoarthritis between 2001 and 2023.
• Multivariable Cox proportional-hazards regression analysis to assess revision risk, adjusting for relevant covariates.

Main Results:

• A total of 92,923 TKA cases were analyzed (48,846 with antioxidants, 44,077 without).
• The 13-year revision incidence was lower in the antioxidant group (3.4%) compared to the non-antioxidant group (4.2%).
• After adjustment, the antioxidant group showed a significantly lower risk of all-cause revision (HR 0.86) and revision for wear (HR 0.41).

Conclusions:

• Total knee arthroplasty with highly cross-linked polyethylene (HXLPE) incorporating antioxidants demonstrates a reduced risk of all-cause revision.
• The addition of antioxidants to HXLPE is associated with a significantly lower risk of revision specifically due to wear.
• These findings suggest a potential benefit of antioxidant-containing HXLPE for improving long-term TKA outcomes.