Abstract
There is no question that excellent long-term results have been demonstrated with all-polyethylene tibial components. Moreover, improvements in polyethylene to increase wear resistance, maintain mechanical strength, and improve oxidative resistance lend even greater credence to the use of an all-polyethylene tibial component. There are several issues of concern. In revision knee replacement for reasons such as patellofemoral problems where the components are otherwise ideal, the arthrotomy performed during the revision usually creates a slight laxity requiring a thicker polyethylene or even a different tibial conformity. With an all-polyethylene tibia, this would require full component revision. It is also true that, even after careful trial reduction, the surgeon occasionally will find that the final construct is slightly lax requiring a thicker final insert. This again is difficult in the situation of all-polyethylene tibia. One of the advantages of an all-polyethylene tibia is to avoid back-sided wear that posed a substantial problem in the past. Most component systems have successfully dealt with a problem of back-sided wear making the advantage of a nonmodular all-polyethylene tibia moot. Finally, in a modular system, the surgeon has the advantage of cementing all components with the tibial trial and then having the ability to remove the trial component, clear the back of the knee and insert the final insert. Lowering health care costs is a laudable and necessary endeavor. We must choose TKR implants to fit patient demand and not overuse or underuse technology and know the true cost of the implants we use.
