S Raja Balgovind, Gowda Aditya K S, Ansari Sajid, Choudhury Arghya Kundu, Kalia Roop Bhushan
Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203 India.
Indian J Orthop. 2021 Aug 23;55(5):1076-1086. doi: 10.1007/s43465-021-00494-3. eCollection 2021 Oct.
Total knee arthroplasty (TKA) has improved leaps and bounds in terms of design to improve clinical outcomes and achieve better rehabilitation of the patients. Ultra-congruent inserts (UC) were designed to replace the need for posterior stabilized (PS) implants. The purpose of this review was to evaluate clinical outcomes, femoral rollback, functional scores, range of motion, sagittal laxity, complication rates, and isokinetic performance between UC and PS TKA among RCTs.
Electronic databases such as PubMed, Scopus, opengrey, and Cochrane were searched from date of inception up to mid-April 2021, and meta-analysis was performed following PRISMA guidelines. This study analyzed outcomes, femoral rollback, tibial sagittal laxity and isokinetic performance.
Ten RCTs identified 852 knees, of which 420 underwent UC TKAs and 432 underwent PS TKA. Compared to UC TKA, a significantly better sagittal stability ( = 0.17) and femoral rollback ( < 0.00001) in PS TKAs was noted, although no statistically significant difference was found in the assessment of the range of motion ( = 0.19) and functional scores. Both the groups had similar isokinetic performance with extensor torque ( = 0.97) and flexor torque ( = 0.37).
We conclude with the current meta-analysis that there are no added benefits for UC over PS inserts and these inserts have a higher sagittal laxity and less femoral roll back in cruciate sacrificing UC knee. But since there are no long-term wear data, UC inserts with CS technique should be used cautiously and may be used only when the PCL cannot be balanced adequately. There is no evidence or only a few to support the superiority of the AS TKA in terms of clinical outcomes or isokinetic performance or femoral external rotation over PS TKA.
Level I, Systematic review and meta-analysis of RCTs.
全膝关节置换术（TKA）在设计方面有了飞跃式的进步，以改善临床结果并实现患者更好的康复。超匹配型垫片（UC）被设计用于取代后稳定型（PS）植入物的需求。本综述的目的是评估随机对照试验（RCT）中UC和PS TKA之间的临床结果、股骨后滚、功能评分、活动范围、矢状面松弛度、并发症发生率和等速运动表现。
检索了PubMed、Scopus、opengrey和Cochrane等电子数据库，检索时间从建库至2021年4月中旬，并按照PRISMA指南进行荟萃分析。本研究分析了结果、股骨后滚、胫骨矢状面松弛度和等速运动表现。
10项RCT共纳入852个膝关节，其中420个接受UC TKA，432个接受PS TKA。与UC TKA相比，PS TKA的矢状面稳定性显著更好（=0.17），股骨后滚更明显（<0.00001），不过在活动范围评估（=0.19）和功能评分方面未发现统计学显著差异。两组的等速运动表现相似，伸肌扭矩（=0.97）和屈肌扭矩（=0.37）。
通过当前的荟萃分析，我们得出结论，UC垫片相对于PS垫片没有额外益处，在牺牲交叉韧带的UC膝关节中，这些垫片矢状面松弛度更高，股骨后滚更小。但由于缺乏长期磨损数据，采用保留交叉韧带（CS）技术的UC垫片应谨慎使用，仅在无法充分平衡后交叉韧带（PCL）时方可使用。没有证据或仅有少数证据支持在临床结果、等速运动表现或股骨外旋方面，保留交叉韧带（AS）TKA优于PS TKA。
I级，RCT的系统评价和荟萃分析。
