Five-Year Comparison of Oxidized Zirconium and Cobalt-Chromium Femoral Components in TKA

A Randomized Controlled Trial

By Catherine Hui, MD, FRCS(C), Lucy Salmon, BAppSci (Physio), PhD, Shinichi Maeno, MD, PhD, Justin Roe, MBBS, FRACS, William Walsh, PhD, and Leo Pinczewski, MBBS, FRACS

Investigation performed at the North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, New South Wales, Australia

J Bone Joint Surg Am. 2011;93:624-30 d doi:10.2106/JBJS.I.01753

Background: In vitro analysis has shown that oxidized zirconium on ultra-high molecular weight polyethylene has better wear properties than cobalt-chromium on ultra-high molecular weight polyethylene. The purpose of this study was to determine if oxidized zirconium femoral components performed better than cobalt-chromium in vivo and if the use of oxidized zirconium components had clinical adverse effects.

Methods: Forty consecutive patients (eighty knees) underwent simultaneous bilateral cruciate-retaining total knee arthroplasty for primary osteoarthritis from January 2002 to December 2003. For each patient, the knees were randomized to receive the oxidized zirconiumfemoral component, with the contralateral knee receiving the cobalt-chromiumcomponent. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score, Knee Society score, and British Orthopaedic Association patient satisfaction scale. Radiographic outcomes include the Knee Society total knee arthroplasty roentgenographic evaluation and scoring system and measurement of radiographic wear. Patients and assessors were blinded to the treatment groups and results.

Results: There were no significant differences in clinical, subjective, and radiographic outcomes between the two implants at five days, six weeks, and one, two, or five years postoperatively. At five years following surgery, 38% of the patients preferred the cobalt-chromium knee compared with 18% who preferred the oxidized zirconium knee (p = 0.02) and 44% had no preference.

Conclusions: Five-year outcomes after total knee arthroplasty with oxidized zirconium and cobalt-chromium femoral components showed no significant differences in clinical, subjective, and radiographic outcomes. Patients had no preference or preferred the cobalt-chromium prosthesis to the oxidized zirconium prosthesis at the time of the five-year followup. There were no adverse effects associated with the use of oxidized zirconium femoral implants.