All - Polyethylene tibial component has finally proved its metal (by avoiding metal)

Initial total knee prosthesis had an all polyethylene tibial component. They went out of favour because of fears of subsidence and early failure. Metal backed components were introduced with claims of better load distribution to the proximal tibia and consequently less subsidence and loosening.
However advantages of the all polyethylene tibia cannot be ignored. The component is monoblock thereby completely eliminating backside wear. Moreover it is cheaper making the surgery more cost effective.
So what is the current status of the all polyethylene tibial component?
A ten year randomized controlled trial comparing all poly with metal backed components found no difference in the two components. They studied 566 knees.
Blumenfeld et al in a literature review recommended all poly components in older patients and less active younger patients. The only disadvantages they mentioned were an inability to change liner thickness after final component cementing and inability to use constrained inserts. Also poly exchange is not possible.
Another study in JBJS Am published in 2010 also supports the use of all poly tibial components.

As always there is another side of the coin. So check for yourself and decide. Happy replacing!!