Ceramic Coating in Cemented Primary Total Knee Arthroplasty
Ceramic Coating in Cemented Primary Total Knee Arthroplasty is
Not Associated With Decreased Risk of Revision due to Early
Prosthetic Joint Infection –
Alexander W. Grimberg,MD, Thomas M. Grupp, PhD, Johanna Elliott, MD
Oliver Melsheimer, PhD, Volkmar Jansson, PhD, Arnd Steinbrück, MD
Contents lists available at Science Direct – The Journal of Arthroplasty – 2020-09-08
Prosthetic joint infection (PJI) is one of the most frequent and devastating causes of shortterm revision total knee arthroplasty (TKA). In vitro evidence suggests ceramic surfaces demonstrate resistance to biofilm, but the clinical effect of bearing surface modifications on the risk of PJI remains unclear. This premier registry-based study examines the influence of ceramic bearing surface coatings on the outcome in cemented primary TKA.
In total, 117,660 cemented primary TKAs in patients with primary osteoarthritis recorded in the German arthroplasty registry since 2012 were followed up for a maximum of 3 years. The primary endpoint was risk of revision for PJI on ceramic coated and uncoated cobalt-chromium-molybdenum femoral components. Propensity score matching for age, gender, obesity, diabetes mellitus, depression and Elixhauser comorbidity index, and substratification on common design twins with and without coating was performed.
In total, 4637 TKAs (85.1% female) with a ceramic-coated femoral component were identified, 42 had been revised for PJI and 122 for other reasons at 3 years. No survival advantage due to the risk of revision for PJI could be determined for ceramic coated components. Revision for all other reasons demonstrated a significant higher rate for TKAs with ceramic-coated components. However, the results of this were confounded by a strong prevalence (20.7% vs 0.3%) of metal sensitivity in the ceramic-coated
No evidence of reduced risk for PJI due to ceramic-coated implants in cemented primary TKA was found. Further analysis for revision reasons other than PJI is required.
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Alexander W. Grimberg, MD