{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T14:14:21Z","timestamp":1771251261501,"version":"3.50.1"},"reference-count":17,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ActaO"],"abstract":"<jats:p>Background and purpose:\u00a0Radiostereometric analysis (RSA) of total knee arthroplasty (TKA) is used as an early safeguard during the phased evidence-based introduction of new implants. The goal of our study was to compare the long-term revision risk between RSA-tested implants and non-RSA-tested implants in the Netherlands using patient-level data.Methods:\u00a0All primary TKAs between 2007 and 2016 from the Dutch Arthroplasty Register were included, and procedures with an RSA-tested implant were identified. Both all-cause major revision risk and revision risk because of loosening were calculated at 5 and 10 years postoperatively using Kaplan\u2013Meier analyses. Sensitivity analyses were performed with stricter definitions of implant characteristics to classify procedures as RSA-tested, to avoid camouflage of different subdesigns within the same brand implant portfolio.Results:\u00a083,638 RSA-tested and 104,105 non-RSA-tested TKAs were included. Cumulative all-cause major revision percentages for the RSA-tested group at 5 and 10 years were 2.2% (95% confidence interval [CI] 2.1\u20132.3) and 3.6% (CI 3.4\u20133.7), respectively, compared with 2.5% (CI 2.4\u20132.6) and 3.3% (CI 3.2\u20133.4) for the non-RSA-tested group. RSA-tested TKAs showed higher 10-year revision risks because of loosening than non-RSA-tested procedures (1.8%, CI 1.7\u20131.9 vs 1.4%, CI 1.3\u20131.4, respectively). Comparable results were found after stratification by various patient characteristics and with stricter classification approaches.Conclusion:\u00a0Regarding all-cause revision risk, RSA-tested TKAs had a slightly lower risk at 5 years. However, at 10 years the RSA-tested TKAs had a higher all-cause revision risk and higher revision risk because of loosening compared with the non-RSA-tested TKAs.<\/jats:p>","DOI":"10.2340\/17453674.2026.45293","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T13:31:43Z","timestamp":1771248703000},"source":"Crossref","is-referenced-by-count":0,"title":["The long-term revision risk of RSA-tested and non-RSA-tested TKA implants in The Netherlands: a Dutch arthroplasty register study"],"prefix":"10.2340","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0638-6568","authenticated-orcid":false,"given":"Thies J N","family":"Van der Lelij","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5351-5057","authenticated-orcid":false,"given":"Bart G","family":"Pijls","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8772-9985","authenticated-orcid":false,"given":"Bart L","family":"Kaptein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8141-842X","authenticated-orcid":false,"given":"Liza N","family":"Van Steenbergen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1228-4162","authenticated-orcid":false,"given":"Rob G H H","family":"Nelissen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Perla J","family":"Marang-van de Mheen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1183","published-online":{"date-parts":[[2026,2,16]]},"reference":[{"key":"141799","doi-asserted-by":"crossref","unstructured":"Nelissen R G, Pijls B G, K\u00e4rrholm J, Malchau H, Nieuwenhuijse M J, Valstar E R. RSA and registries: the quest for phased introduction of new implants. J Bone Joint Surg Am 2011; 93(Suppl 3): 62-5. doi: 10.2106\/jbjs.K.00907.","DOI":"10.2106\/JBJS.K.00907"},{"key":"141800","doi-asserted-by":"crossref","unstructured":"Pijls B G, Valstar E R, Nouta K A, Plevier J W, Fiocco M, Middeldorp S, et al. Early migration of tibial components is associated with late revision: a systematic review and meta-analysis of 21,000 knee arthroplasties. Acta Orthop 2012; 83(6): 614-24. doi: 10.3109\/17453674.2012.747052.","DOI":"10.3109\/17453674.2012.747052"},{"key":"141801","doi-asserted-by":"crossref","unstructured":"Pijls B G, Plevier J W M, Nelissen R. RSA migration of total knee replacements. Acta Orthop 2018; 89(3): 320-8. doi: 10.1080\/17453674.2018.1443635.","DOI":"10.1080\/17453674.2018.1443635"},{"key":"141802","doi-asserted-by":"crossref","unstructured":"Hasan S, Marang-van de Mheen P J, Kaptein B L, Nelissen R, Pijls B G. RSA-tested TKA implants on average have lower mean 10-year revision rates than non-RSA-tested designs. Clin Orthop Relat Res 2020; 478(6): 1232-41. doi: 10.1097\/corr.0000000000001209.","DOI":"10.1097\/CORR.0000000000001209"},{"key":"141803","doi-asserted-by":"crossref","unstructured":"Wilton T, Skinner J A, Haddad F S. Camouflage uncovered: what should happen next? Bone Joint J 2023; 105-b(3): 221-6. doi: 10.1302\/0301-620x.105b3.Bjj-2023-0145.","DOI":"10.1302\/0301-620X.105B3.BJJ-2023-0145"},{"key":"141804","doi-asserted-by":"crossref","unstructured":"Phillips J R A, Tucker K. Implant brand portfolios, the potential for camouflage of data, and the role of the Orthopaedic Data Evaluation Panel in total knee arthroplasty. Bone Joint J 2021; 103-b(10): 1555-60. doi: 10.1302\/0301-620x.103b10.Bjj-2021-0284.R1.","DOI":"10.1302\/0301-620X.103B10.BJJ-2021-0284.R1"},{"key":"141805","doi-asserted-by":"crossref","unstructured":"Marang-van de Mheen P J, Nallamothu B K. Exclusions in the denominators of process-based quality measures: the missing link in understanding performance or ecological fallacy? BMJ Qual Saf 2017; 26(3): 169-73. doi: 10.1136\/bmjqs-2016-005254.","DOI":"10.1136\/bmjqs-2016-005254"},{"key":"141806","doi-asserted-by":"crossref","unstructured":"van Steenbergen L N, Denissen G A, Spooren A, van Rooden S M, van Oosterhout F J, Morrenhof J W, et al. More than 95% completeness of reported procedures in the population-based Dutch Arthroplasty Register. Acta Orthop 2015; 86(4): 498-505. doi: 10.3109\/17453674.2015.1028307.","DOI":"10.3109\/17453674.2015.1028307"},{"key":"141807","doi-asserted-by":"crossref","unstructured":"Denissen G A W, van Steenbergen L N, Lollinga W T, Verdonschot N J J, Schreurs B W, Nelissen R. Generic implant classification enables comparison across implant designs: the Dutch Arthroplasty Register implant library. EFORT Open Rev 2019; 4(6): 344-50. doi: 10.1302\/2058-5241.4.180063.","DOI":"10.1302\/2058-5241.4.180063"},{"key":"141808","doi-asserted-by":"crossref","unstructured":"von Elm E, Altman D G, Egger M, Pocock S J, G\u00f8tzsche P C, Vandenbroucke J P. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370(9596): 1453-7. doi: 10.1016\/s0140-6736(07)61602-x.","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"141809","doi-asserted-by":"crossref","unstructured":"Ranstam J. Why the P-value culture is bad and confidence intervals a better alternative. Osteoarthritis Cartilage 2012; 20(8): 805-8. doi: https:\/\/doi.org\/10.1016\/j.joca.2012.04.001.","DOI":"10.1016\/j.joca.2012.04.001"},{"key":"141810","doi-asserted-by":"crossref","unstructured":"Catani F, Leardini A, Ensini A, Cucca G, Bragonzoni L, Toksvig-Larsen S, et al. The stability of the cemented tibial component of total knee arthroplasty: posterior cruciate-retaining versus posterior-stabilized design. J Arthroplasty 2004; 19(6): 775-82. doi: 10.1016\/j.arth.2004.01.013.","DOI":"10.1016\/j.arth.2004.01.013"},{"key":"141811","unstructured":"Exactech. US Exactech Recall Information. Knee and Ankle Polyethylene 2022. Available from: https:\/\/www.exac.com\/recall-information\/"},{"key":"141812","doi-asserted-by":"crossref","unstructured":"Gkiatas I, Karasavvidis T, Sharma A K, Xiang W, Malahias M A, Chalmers B P, et al. Highly cross-linked polyethylene in primary total knee arthroplasty is associated with a lower rate of revision for aseptic loosening: a meta-analysis of 962,467 cases. Arch Orthop Trauma Surg 2022; 142(6): 1177-84. doi: 10.1007\/s00402-021-03887-z.","DOI":"10.1007\/s00402-021-03887-z"},{"key":"141813","doi-asserted-by":"crossref","unstructured":"Bonsignore L A, Goldberg V M, Greenfield E M. Machine oil inhibits the osseointegration of orthopaedic implants by impairing osteoblast attachment and spreading. J Orthop Res 2015; 33(7): 979-87. doi: 10.1002\/jor.22850.","DOI":"10.1002\/jor.22850"},{"key":"141814","doi-asserted-by":"crossref","unstructured":"van der Lelij T J N, Kaptein B L, Tsonaka R, Nelissen R, Toksvig-Larsen S, Marang-van de Mheen P J. Tibial baseplate migration is not associated with change in patient-reported outcome measures and clinical scores after TKA: A secondary analysis of 5 radiostereometric analysis studies with 10-year follow-up. J Bone Joint Surg Am 2024; 106(16): 1479-85. doi: 10.2106\/jbjs.23.00957.","DOI":"10.2106\/JBJS.23.00957"},{"key":"141815","unstructured":"Orthopaedic Data Evaluation Panel (ODEP). Available from: https:\/\/www.odep.org.uk\/"}],"container-title":["Acta Orthopaedica"],"original-title":[],"link":[{"URL":"https:\/\/actaorthop.org\/actao\/article\/download\/45293\/52848","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/actaorthop.org\/actao\/article\/download\/45293\/52865","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/actaorthop.org\/actao\/article\/download\/45293\/52866","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/actaorthop.org\/actao\/article\/download\/45293\/52848","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T13:31:52Z","timestamp":1771248712000},"score":1,"resource":{"primary":{"URL":"https:\/\/actaorthop.org\/actao\/article\/view\/45293"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,16]]},"references-count":17,"URL":"https:\/\/doi.org\/10.2340\/17453674.2026.45293","relation":{},"ISSN":["1745-3682","1745-3674"],"issn-type":[{"value":"1745-3682","type":"electronic"},{"value":"1745-3674","type":"print"}],"subject":[],"published":{"date-parts":[[2026,2,16]]}}}