Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, 299-0111 Ichihara, Chiba, Japan.
Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, 299-0111 Ichihara, Chiba, Japan.
Orthop Traumatol Surg Res. 2019 Jun;105(4):619-626. doi: 10.1016/j.otsr.2019.03.006. Epub 2019 Apr 27.
Precise implant alignment is a crucial prognostic factor in total knee arthroplasty (TKA). Portable navigation systems (PN-TKA) were reported to be better than the conventional technique (CON-TKA). We hypothesized that PN-TKA offered greater radiologic precision than CON-TKA in mechanically aligning components. We investigated whether (1) it improved global mechanical alignment, and (2) optimized component placement with respect to the tibial and femoral mechanical axes.
A systematic literature review compared PN-TKA versus CON-TKA. PubMed, Web of Science and Cochrane Library search retrieved ten studies. Their data were pooled using RevMan 5.3. Odds ratios (OR) for dichotomous data were calculated with 95% confidence intervals (CIs) for each outcome. Statistical heterogeneity was assessed as I using a standard χ test. I>50% denoted significant heterogeneity requiring a random effects model; otherwise, a fixed effects model was applied.
There were significantly fewer outliers for mechanical axis (I=24%, OR=0.62, 95% CI=0.42-0.91, p=0.02) and coronal femoral component angle (I=58%, OR=0.31, 95% CI=0.13-0.73, p=0.007) using PN-TKA; however, no significant difference was observed for coronal tibial component angle outliers (I=0%, OR=0.66, 95% CI=0.38-1.15, p=0.14).
Although PN-TKA appeared to improve global alignment, it had no effect on coronal tibial alignment, which is a key factor in predicting the long-term success of component fixation. There thus appeared to be no definite advantage of PN-TKA over CON-TKA.
III.
精准的植入物对线是全膝关节置换术（TKA）的一个关键预后因素。便携式导航系统（PN-TKA）被报道优于传统技术（CON-TKA）。我们假设 PN-TKA 在机械对线方面比 CON-TKA 具有更高的放射学精度。我们研究了它是否（1）改善了整体机械对线，以及（2）优化了相对于胫骨和股骨机械轴的组件放置。
系统文献回顾比较了 PN-TKA 与 CON-TKA。通过 PubMed、Web of Science 和 Cochrane Library 检索，共检索到十项研究。使用 RevMan 5.3 汇总其数据。对于每个结果，使用 95%置信区间（CI）计算二分类数据的比值比（OR）。使用标准 χ 检验评估统计异质性。I>50%表示存在显著异质性，需要使用随机效应模型；否则，应用固定效应模型。
使用 PN-TKA 时，机械轴的离群值明显减少（I=24%，OR=0.62，95%CI=0.42-0.91，p=0.02）和冠状股骨组件角度的离群值（I=58%，OR=0.31，95%CI=0.13-0.73，p=0.007）；然而，冠状胫骨组件角度的离群值没有显著差异（I=0%，OR=0.66，95%CI=0.38-1.15，p=0.14）。
尽管 PN-TKA 似乎改善了整体对线，但对冠状胫骨对线没有影响，而这是预测组件固定长期成功的关键因素。因此，PN-TKA 似乎没有明显优于 CON-TKA 的优势。
III。
