ArticleEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2026
Polyethylene thickness showed no significant association with implant survival in primary posterior-stabilized total knee arthroplasty at 13-year follow-up: a regional registry-based study of 5625 crosslinked inserts.
Article in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThe influence of polyethylene (PE) insert thickness on long-term implant survival after total knee arthroplasty (TKA) remains controversial. Thicker PE inserts are generally reserved for cases in which adequate ligament balance cannot otherwise be achieved, but their impact on implant survivorship is unclear.
methodsThis registry-based retrospective study analyzed primary posterior-stabilized (PS) TKAs implanted between 2007 and 2020 and recorded in the Emilia-Romagna Orthopedic Prosthetic Implant Registry (RIPO). Only fixed-bearing crosslinked polyethylene inserts were included. PE thickness was categorized into three groups (8-10 mm, 11-12 mm, and ≥ 13 mm). The endpoint was revision of any TKA component for any cause. Implant survivorship was assessed using Kaplan-Meier analysis and multivariable Cox regression adjusted for age and sex.
resultsA total of 5625 crosslinked PE inserts were analyzed. Inserts of 8-10 mm accounted for 69.8% of cases, followed by 11-12 mm (23.9%) and ≥ 13 mm (6.2%). At 13 years, implant survival was 94.6% (95% CI 93.3-95.5) for 8-10 mm inserts, 93.3% (95% CI 89.4-95.8) for 11-12 mm inserts, and 88.9% (95% CI 74.6-95.6) for ≥ 13 mm inserts. Additionally, 302, 125, and 38 patients in the respective groups died during follow-up and were censored in the survival analysis. No statistically significant differences in survivorship were observed among thickness groups (log-rank p = 0.50). Adjusted hazard ratios did not demonstrate an increased risk of revision associated with greater PE thickness.
conclusionIn this large registry-based cohort of primary PS TKAs using crosslinked polyethylene, PE insert thickness was not statistically associated with long-term implant survival. Although thicker inserts showed a numerically lower survivorship, this difference was not statistically significant and should be interpreted with caution. Further studies incorporating clinical, radiographic, and failure-specific data are warranted.
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