Page 47 - ISAKOS 2021 Newsletter Volume 1

In conclusion, what constitutes practice-changing evidence should be judiciously considered, with surgeons recognizing the intrinsic cognitive biases that can act as barriers to implementing prosthesis change, thereby creating an evidence-utilization incongruity and a resultant persistence of failed design innovations. A useful and pragmatic comparator of registry survivorship is a combination of the lowest-risk design options based on national data. On the basis of AOANJRR data, the lowest-risk TKR prosthesis is one with the following features: a cemented tibial implant; a minimally stabilized design; a fixed bearing, cross-linked polyethylene bearing surface; and patellar resurfacing.
References
1. Vertullo CJ, Lewis PL, Graves S, Kelly L, Lorimer M, Myers P. Twelve- Year Outcomes of an Oxinium Total Knee Replacement Compared with the Same Cobalt-Chromium Design: An Analysis of 17,577 Prostheses from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am. 2017 Feb 15;99(4):275– 283. 2. Vertullo CJ, Lewis PL, Lorimer M, Graves SE. The Effect on Long-Term Survivorship of Surgeon Preference for Posterior-Stabilized or Minimally Stabilized Total Knee Replacement: An Analysis of 63,416 Prostheses from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Jt Surg. 2017 Jul;99(13):1129– 1139. 3. Dunbar MJ, Richardson G, Robertsson O. I can’t get no satisfaction after my total knee replacement. Bone Jt J. 2013;95(11 Suppl A):148–152. 4. Vertullo CJ, Graves SE, Peng Y, Lewis PL. An optimum prosthesis combination of low-risk total knee arthroplasty options in all five primary categories of design results in a 60% reduction in revision risk: a registry analysis of 482,373 prostheses. Knee Surg Sports Traumatol Arthrosc [Internet]. 2018 Aug 20 [cited 2018 Aug 26]; Available from: http://link.springer.com/10.1007/s00167-018-5115-z 5. Malchau H. Introducing new technology: a stepwise algorithm. Spine. 2000 Feb 1;25(3):285.
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ISAKOS NEWSLETTER 2021: VOLUME I 45