All-polyethylene Tibial Components in Modern Total Knee Arthroplasty

Most total knee arthroplasty prostheses have modular tibial components with metal-backed tibial baseplates. Biomechanical studies have demonstrated mechanical advantages to a metal-backed tibial component in terms of tibial load transfer. In addition, tibial component modularity provides intraoperative flexibility and may provide an advantage in the setting of subsequent revision knee surgery. However, clinical evidence does not support the preferential use of metal-backed tibial components. Modularity introduces the potential for backside wear and associated osteolysis. Also, several recent studies have shown no significant differences in clinical and radiographic outcomes between metal-backed and all-polyethylene tibial components. In addition, all-polyethylene tibial components are less expensive than metal-backed components; increased usage of all-polyethylene components could help decrease the cost of health care.