University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, Singapore.
J Knee Surg. 2021 May;34(6):648-658. doi: 10.1055/s-0039-1700494. Epub 2019 Nov 4.
The main purpose of this article is to provide an up-to-date systematic review and meta-analysis comparing functional outcomes of total knee arthroplasty using either computer navigation (NAV-TKA) or conventional methods (CON-TKA) from the latest assemblage of evidence. This study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology guidelines. All Level I and II randomized controlled trials (RCTs) in PubMed, EMBASE, and Cochrane that compared functional outcomes after NAV- and CON-TKA were included in the review. Selected end points for random effects, pairwise meta-analysis included Knee Society Knee Score (KSKS), KS Function Score (KSFS), KS Total Score (KSTS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and range of motion at three arbitrary follow-up times. A total of 24 prospective RCTs comprising 3,778 knees were included from the initial search. At long-term follow-up (>5 years), NAV-TKA exhibited significantly better raw KSKS ( = 0.001) (low-quality evidence), contrary to CON-TKA, which reflected significantly better raw KSTS ( = 0.004) (high-quality evidence). While change scores (KSKS, WOMAC) from preoperative values favor CON-TKA at short-term (<6 months) and medium-term follow-up (6-60 months), long-term follow-up change scores in KSKS suggest the superiority of NAV-TKA over CON-TKA ( = 0.02) (very low-quality evidence). Overall, sizeable dispersion of nonstatistically significant functional outcomes in the medium term was observed to eventually converge in the long term, with less differences in functional outcome scores between the two treatment methods in short- and long-term follow-up. While raw functional outcome scores reflect no differences between NAV and CON-TKA, long-term follow-up change scores in KSKS suggest superiority of NAV-TKA over its conventional counterpart. Prospective studies with larger power are required to support the pattern of diminishing differences in functional outcome scores from medium- to long-term follow-up between the two modalities.
本文的主要目的是提供最新的系统评价和荟萃分析，比较使用计算机导航（NAV-TKA）或传统方法（CON-TKA）进行全膝关节置换术的功能结果，这些结果来自最新的证据汇总。这项研究是根据系统评价和荟萃分析的首选报告项目以及观察性研究的荟萃分析流行病学指南进行的。在 PubMed、EMBASE 和 Cochrane 中，所有一级和二级随机对照试验（RCT），比较 NAV-TKA 和 CON-TKA 后的功能结果均纳入了本综述。随机效应、成对荟萃分析的选择终点包括膝关节学会膝关节评分（KSKS）、KS 功能评分（KSFS）、KS 总评分（KSTS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）以及三个任意随访时间的关节活动度。从最初的搜索中，共纳入了 24 项前瞻性 RCT，包含 3778 个膝关节。在长期随访（>5 年）中，与 CON-TKA 相比，NAV-TKA 显示出明显更好的原始 KSKS（ = 0.001）（低质量证据），而 CON-TKA 则反映出明显更好的原始 KSTS（ = 0.004）（高质量证据）。尽管短期（<6 个月）和中期（6-60 个月）随访的变化评分（KSKS、WOMAC）对 CON-TKA 有利，但长期随访的 KSKS 变化评分表明 NAV-TKA 优于 CON-TKA（ = 0.02）（极低质量证据）。总的来说，在中期观察到大量非统计学上显著的功能结果的分散，最终在长期随访中趋于收敛，两种治疗方法的功能结果评分之间的差异在短期和长期随访中较小。虽然原始功能结果评分在 NAV 和 CON-TKA 之间没有差异，但 KSKS 的长期随访变化评分表明 NAV-TKA 优于其常规对照。需要进行更大规模的前瞻性研究，以支持两种方法从中期到长期随访的功能结果评分差异逐渐缩小的模式。
