Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Orthopedic Surgery, Tongji University School of Medicine, Tongji Hospital, Shanghai, China.
J Knee Surg. 2021 Oct;34(12):1368-1378. doi: 10.1055/s-0040-1709490. Epub 2020 Jun 5.
As more patients undergo total knee arthroplasty (TKA) each year, and the average age of patients gets younger, the patients are generally more active requiring a greater physiological demand and increasing range of motion on the prosthesis than the previous patients. However, there is no consensus on the optimal TKA tibial bearing design. We performed this systematic review to compare the clinical differences between mobile and fixed bearing constructs used in contemporary TKA. We searched PubMed, EMBASE, and Cochrane Library databases, identifying 515 total publications, including 17 randomized controlled trials (RCTs). A meta-analysis was performed, while the quality and bias of the evidence were rated according to the Grading of Recommendations Assessment Development and Evaluation (GRADE) guidelines and the Cochrane Database questionnaire. The meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Seventeen studies were included, with a total of 1505 knees receiving a mobile bearing TKA and 1550 knees receiving a fixed bearing TKA. The meta-analysis compared clinical outcomes between mobile bearing (MB)-TKA and fixed bearing (FB)-TKA using postoperative Knee Society Score, postoperative ROM, and survivorship and showed that there was a distinct difference in Knee Society Score between the mobile-bearing and fixed-bearing groups (overall standardized mean difference = 1.38; 95% confidence interval (CI): 0.50-2.25; = 0.002; I = 60%). Patients treated with mobile-bearing prostheses were more likely to report good or excellent range of motion results (overall standardized mean difference = 2.06; 95% CI: 0.65-3.47; = 0.004). No difference in implant survivorship or reoperation rate were identified. The fixed-bearing and mobile-bearing TKA designs are both capable of producing excellent long-term results with excellent clinical outcomes if properly implanted; however, the mobile-bearing TKA have superiority in mid- to long-term clinical results. Trial registration number for PROSPERO was CRD42019126402.
随着每年接受全膝关节置换术 (TKA) 的患者越来越多，且患者的平均年龄越来越年轻，他们通常比以前的患者更加活跃，对假体的生理需求更大，活动范围也更广。然而，对于 TKA 胫骨轴承设计的最佳选择还没有达成共识。我们进行了这项系统综述，以比较在现代 TKA 中使用的活动和固定轴承结构之间的临床差异。我们检索了 PubMed、EMBASE 和 Cochrane Library 数据库，共识别出 515 篇全文出版物，包括 17 项随机对照试验 (RCT)。我们进行了 meta 分析，同时根据推荐评估、制定与评价 (GRADE) 指南和 Cochrane 数据库问卷对证据的质量和偏倚进行了评估。meta 分析是根据系统评价和荟萃分析的首选报告项目 (PRISMA) 指南进行的。共纳入 17 项研究，共计 1505 例膝关节接受活动轴承 TKA，1550 例膝关节接受固定轴承 TKA。meta 分析比较了移动轴承 (MB)-TKA 和固定轴承 (FB)-TKA 的临床结果，使用术后膝关节学会评分、术后 ROM 和生存率，并表明移动轴承和固定轴承组之间的膝关节学会评分存在明显差异（总体标准化平均差异=1.38；95%置信区间[CI]：0.50-2.25； =0.002；I=60%）。接受活动轴承假体治疗的患者更有可能报告良好或优秀的活动范围结果（总体标准化平均差异=2.06；95%CI：0.65-3.47； =0.004）。在假体存活率或再手术率方面没有差异。如果正确植入，固定轴承和活动轴承 TKA 设计都能产生出色的长期结果和出色的临床结果；然而，在中至长期临床结果方面，活动轴承 TKA 具有优势。PROSPERO 的临床试验注册号为 CRD42019126402。
