Early Experience with Vitamin E Antioxidant-Infused Highly Cross-Linked Polyethylene Inserts in Primary Total Knee Arthroplasty
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Abstract: Background: In past decades, polyethylene wear was a major cause of failure in total knee arthroplasty (TKA). Polyethylene for use in arthroplasty has been vastly improved in recent years, with improved materials as well as manufacturing and sterilization processes. Testing has shown that infusion of vitamin E prevents oxidative degradation of polyethylene without remelting, allowing the material to maintain mechanical properties and wear resistance over time. The purpose of this study is to review the early result of patients undergoing primary TKA with vitamin E antioxidant-infused polyethylene inserts. Materials and Methods: A query of our practice registry revealed 148 patients (163 knees) who underwent primary cemented TKA using the Vanguard® Complete Knee System and E1® Antioxidant Infused polyethylene bearings (Zimmer Biomet, Warsaw, Indiana) between May 2009 and May 2013. Indications for E1® bearings were younger, more active patients. There were 65 males (44%) and 82 females (56%). Mean age was 50.6 years and mean BMI was 37.3 kg/m2. Results: At mean follow-up of 3.2 years (range 6 weeks to 6.4 years), there have been seven revisions (4.3%): three two-staged exchanges for infection, two for arthrofibrosis (one insert only, one femoral and tibial), and two (insert only) for late instability with imbalanced tight posteromedial and loose lateral structures. No aseptic loosening has occurred. Mean range of motion improved from 108° preoperatively to 112°, Knee Society clinical scores improved from 36 to 84 and function scores from 56 to 66. Postoperative radiographs, available for 160 TKA, revealed lateral patellar tilt in one knee, and satisfactory position, alignment, and fixation in all others. Conclusion: At up to 6.4 years' follow-up, two mechanical failures of the device have occurred and no aseptic loosening. Survival was 100% with aseptic loosening as the endpoint, and 95.7% with revision for any reason as the endpoint. Authors: Emilie M. Flament, Pre-medical Y4, Florida Southern College, Lakeland, Florida, Research Intern, Joint Implant Surgeons, Inc., New Albany, Ohio, Keith R. Berend, MD, Vice President, Joint Implant Surgeons, Inc., New Albany, Ohio, Chief Executive Officer and President, White Fence Surgical Suites, New Albany, Ohio, Attending Surgeon, Mount Carmel Health System, Columbus, OH, Jason M. Hurst, MD, Secretary, Joint Implant Surgeons, Inc., New Albany, Ohio, Chief Operating Officer, White Fence Surgical Suites, New Albany, Ohio, Attending Surgeon, Mount Carmel Health System, Columbus, Ohio, Michael J. Morris, MD, Treasurer, Joint Implant Surgeons, Inc., New Albany, Ohio, Attending Surgeon, Mount Carmel Health System, Columbus, Ohio, Joanne B. Adams, BFA, CMI, Research Director and Medical Illustrator, Joint Implant Surgeons, Inc., New Albany, Ohio, Adolph V. Lombardi Jr., MD, FACS, President, Joint Implant Surgeons, Inc., New Albany, Ohio, Clinical Assistant Professor, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, Attending Surgeon, Mount Carmel Health System, Columbus, Ohio |
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