Institute of Surgical Research, University of Szeged, Szeged, Hungary.
Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.
PLoS One. 2020 May 12;15(5):e0232378. doi: 10.1371/journal.pone.0232378. eCollection 2020.
The potential advantages of hydroxyapatite (HA)-coated cementless total knee arthroplasty (TKA) implants are bone stock preservation and biological fixation. Studies comparing the outcomes of HA-coated cementless, non HA-coated cementless (uncemented) and cemented TKA implants reported contradictory data. Our aim was to provide a comparison of the effects of HA coating of tibial stem on the stability and functionality of TKA implants.
A systematic literature search was performed using MEDLINE, Scopus, EMBASE and the CENTRAL databases up to May 31st, 2019. The primary outcome was Maximum Total Point Motion (MTPM) of the tibial stem. This parameter is determined by radiosterometric analysis and refers to the migration pattern of the prosthesis stems. The clinical outcomes of the implanted joints were evaluated by the Knee Society Knee Score (KSS) and the Knee Society Function Score (KFS). Weighted mean difference (WMD) with 95% confidence interval (CI) were calculated with the random-effects model.
Altogether, 11 randomized controlled trials (RCTs) with 902 patients for primary TKA implants were included. There was a statistically significant difference in the MTPM values with the use of HA-coated and uncoated uncemented implants (WMD = +0.28, CI: +0.01 to +0.56, P<0.001). However, HA-coated stems showed significantly higher migration when compared with the cemented prostheses (WMD = -0.29, CI: -0.41 to -0.16, P<0.001). The KSS values of HA-coated implants were significantly higher than those for the uncemented implants; moreover, KSS and KFS outcome scores were statistically not different between the HA-coated and cemented prosthesis cases.
HA-coating yields better stability than other, uncemented prostheses. More importantly, the HA-coating is not outperformed by cemented prosthesis in providing good functional outcome.
羟基磷灰石（HA）涂层的非骨水泥全膝关节置换术（TKA）植入物具有保留骨量和生物固定的潜在优势。比较 HA 涂层非骨水泥、非 HA 涂层非骨水泥（未骨水泥固定）和骨水泥 TKA 植入物的结果的研究报告的数据相互矛盾。我们的目的是比较胫骨柄 HA 涂层对 TKA 植入物稳定性和功能的影响。
系统检索 MEDLINE、Scopus、EMBASE 和 CENTRAL 数据库，检索截至 2019 年 5 月 31 日。主要结果是胫骨柄的最大总点运动（MTPM）。该参数通过放射测量分析确定，指的是假体柄的迁移模式。植入关节的临床结果通过膝关节协会膝关节评分（KSS）和膝关节协会功能评分（KFS）进行评估。使用随机效应模型计算加权均数差（WMD）和 95%置信区间（CI）。
共纳入 11 项针对初次 TKA 植入物的随机对照试验（RCT），共 902 例患者。HA 涂层和非涂层非骨水泥植入物的 MTPM 值存在统计学差异（WMD=+0.28，CI：+0.01 至+0.56，P<0.001）。然而，与骨水泥假体相比，HA 涂层的胫骨柄迁移明显更高（WMD=-0.29，CI：-0.41 至-0.16，P<0.001）。HA 涂层植入物的 KSS 值明显高于非骨水泥植入物；此外，HA 涂层和骨水泥假体病例的 KSS 和 KFS 结果评分在统计学上没有差异。
HA 涂层比其他非骨水泥假体具有更好的稳定性。更重要的是，HA 涂层在提供良好的功能结果方面并不逊于骨水泥假体。
