Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Veterans Health Service Medical Center, 61 Jinhwangdoro-gil, Gangdong-Gu, Seoul, 134-791, Republic of Korea.
Knee Surg Sports Traumatol Arthrosc. 2018 Nov;26(11):3300-3310. doi: 10.1007/s00167-018-4872-z. Epub 2018 Feb 19.
It is unknown whether the conforming superiority of ultracongruent (UC) inserts over posterior stabilized (PS) inserts, due to an increased anterior lip for prevention of anterior displacement of the condyles during knee flexion, leads to better knee scores or greater knee stability in arthroplasty patients. This meta-analysis compared clinical outcomes, intraoperative kinematics, sagittal stability, and range of motion (ROM) between groups with either UC or PS inserts in primary total knee arthroplasty (TKA).
Studies that recorded clinical outcomes, intraoperative kinematics, sagittal stability, and ROM in patients who underwent primary TKA with UC or PS inserts were included in the meta-analysis. Subgroup analyses based on differences in flexion angles were performed for intraoperative kinematics.
Thirteen studies met the criteria for inclusion in the meta-analysis. The UC and PS insert groups reported similar pain scores (95% CI - 0.15 to 0.16; n.s.) and function scores (95% CI - 0.30 to 0.14; n.s.). In contrast, femoral rotation during flexion (95% CI - 0.06 to 6.35; p = 0.05), posterior femoral translation during flexion (95% CI - 2.74 to - 0.15; p = 0.03), tibial sagittal laxity at 90° (95% CI 2.91 to 7.72; p < 0.0001), and ROM (95% CI - 4.84 to - 1.53; p = 0.0002) differed significantly between the groups. Subgroup analyses revealed that the pooled data for femoral rotation were significantly different between groups: 60°, 4.09 (p < 0.00001); 90°, 7.94 (p < 0.00001); and 120°, 8.16 (p < 0.00001). Furthermore, pooled data for posterior femoral translation were significantly different between groups: 90°, - 3.70 (p < 0.00001); and 120°, - 3.96 (p < 0.00001).
There were no significant differences in clinical outcomes between the groups with UC and PS inserts. However, the UC insert group showed significantly greater external femoral rotation, less posterior femoral translation, greater tibial laxity in the sagittal plane, and less ROM than the PS insert group. Based on the results of the current meta-analysis, in substituting the PCL, PS inserts are preferable to UC inserts due to more favourable kinematics and stability, even though both inserts have equivalent clinical outcomes.
Therapeutic study, Level II.
由于 UC 型假体增加了前唇以防止髁在膝关节屈曲时向前移位，因此其在预防膝关节置换患者前向脱位方面具有优势，但其是否比 PS 型假体具有更好的膝关节评分或更大的膝关节稳定性，目前尚不清楚。本研究通过荟萃分析比较了在初次全膝关节置换术（TKA）中使用 UC 或 PS 型假体的患者之间的临床结果、术中运动学、矢状面稳定性和活动范围（ROM）。
对记录了 UC 或 PS 型假体初次 TKA 患者临床结果、术中运动学、矢状面稳定性和 ROM 的研究进行了荟萃分析。对术中运动学根据屈曲角度的差异进行了亚组分析。
13 项研究符合纳入荟萃分析的标准。UC 型和 PS 型假体组的疼痛评分（95%CI -0.15 至 0.16；无统计学意义）和功能评分（95%CI -0.30 至 0.14；无统计学意义）相似。相比之下，UC 型假体组在膝关节屈曲时的股骨旋转（95%CI -0.06 至 6.35；p=0.05）、股骨后向平移（95%CI -2.74 至 -0.15；p=0.03）、膝关节屈曲 90°时胫骨矢状面松弛度（95%CI 2.91 至 7.72；p<0.0001）和 ROM（95%CI -4.84 至 -1.53；p=0.0002）明显高于 PS 型假体组。亚组分析显示，两组间股骨旋转的汇总数据差异有统计学意义：60°，4.09（p<0.00001）；90°，7.94（p<0.00001）；120°，8.16（p<0.00001）。此外，两组间股骨后向平移的汇总数据差异有统计学意义：90°，-3.70（p<0.00001）；120°，-3.96（p<0.00001）。
UC 型和 PS 型假体组之间的临床结果无显著差异。然而，UC 型假体组的股骨外旋角度更大，股骨后向平移更少，胫骨矢状面松弛度更大，ROM 更小。基于当前荟萃分析的结果，在替代 PCL 时，由于 PS 型假体具有更有利的运动学和稳定性，因此比 UC 型假体更可取，尽管两种假体都有等效的临床结果。
治疗性研究，II 级。
