Department of Orthopaedics, Parul Institute of Medical Sciences and Research, Parul University, Limda, Waghodia, Vadodara, Gujarat, 391760, India.
Sri Dhaatri Orthopaedic, Maternity & Gynaecology Center, SKDGOC, Vijayawada, Andhra Pradesh, 531127, India.
Knee Surg Sports Traumatol Arthrosc. 2022 Sep;30(9):3076-3091. doi: 10.1007/s00167-021-06833-z. Epub 2022 Jan 11.
No systematic review has compared the clinical outcome of anterior stabilized ultra-congruent and standard cruciate-retaining inserts in fixed-bearing primary total knee arthroplasty. This study aimed to compare the outcomes and establish the superiority or equivalence of these inserts.
Pubmed, EMBASE, Medline, AMED, ERIC, and Proquest databases were searched electronically. PRISMA guidelines were followed in the conduct of the study. The clinical outcomes compared in the meta-analysis were overall knee score, WOMAC, score for knee function, score for knee pain, SF-12 PCS, knee flexion, manipulation under anaesthesia for postoperative knee stiffness, revision total knee arthroplasty or change of polyethylene insert for post-operative instability (relative risk [RR]) and survivorship. Study quality was evaluated using the Newcastle Ottawa Scale and the Modified Jadad scale.
Fourteen studies comprising 9989 knees (three RCTs and 11 comparative case-cohort studies) were included for qualitative and quantitative analysis. The pooled analysis of the ultracongruent insert and the standard cruciate retaining insert was based on a cohort of 2860 and 7129 TKA, respectively. Knee pain was significantly better in patients that had standard inserts (p = 0.02; 95% CI - 1.06 to - 0.10), and the physical component of health-related quality of life was also significantly better in patients that had standard inserts (p = 0.02; 95% CI - 6.43 to - 0.64). There was a 72% lesser chance of revision TKA or change of insert for postoperative instability in knees that had been implanted with ultracongruent inserts (RR = 0.28; p = 0.0002; 95% CI 0.15-0.55). There was no difference in the otheroutcome measures. There was no significant difference between the two inserts, considering the minimal clinically important difference or absolute ratio.
Differences observed between the two types of inserts were not clinically significant. Therefore, based on current evidence, arthroplasty surgeons can use either of these inserts with cruciate-retaining knee prosthesis.
Therapeutic study, Level II.
目前尚无系统评价比较固定平台单髁膝关节置换术中应用超等圆襻与标准后交叉韧带保留型胫骨假体的临床疗效。本研究旨在比较这两种胫骨假体的临床结果，并确定它们的优劣。
通过电子检索 Pubmed、EMBASE、Medline、AMED、ERIC 和 Proquest 数据库，并按照 PRISMA 指南进行研究。本荟萃分析比较了总体膝关节评分、WOMAC 评分、膝关节功能评分、膝关节疼痛评分、SF-12 PCS 评分、膝关节屈曲度、术后膝关节僵硬行麻醉下手法松解、全膝关节翻修或因术后不稳定更换聚乙烯衬垫（相对危险度 [RR]）和生存率。使用纽卡斯尔-渥太华量表和改良 Jadad 量表评价研究质量。
共纳入 14 项研究，包含 9989 例膝关节（3 项 RCT 和 11 项对照病例队列研究），进行定性和定量分析。超等圆襻胫骨假体与标准后交叉韧带保留型胫骨假体的汇总分析分别基于 2860 例和 7129 例 TKA。标准胫骨假体组患者的膝关节疼痛明显改善（p=0.02；95%CI -1.06 至 -0.10），标准胫骨假体组患者的健康相关生活质量的生理成分也明显改善（p=0.02；95%CI -6.43 至 -0.64）。使用超等圆襻胫骨假体的膝关节进行全膝关节翻修或因术后不稳定更换聚乙烯衬垫的可能性降低 72%（RR=0.28；p=0.0002；95%CI 0.15-0.55）。其他结果指标两组间无差异。考虑到最小临床重要差异或绝对比值，两种假体之间没有显著差异。
两种假体之间的差异无临床意义。因此，根据现有证据，关节置换外科医生可以在保留后交叉韧带的膝关节假体中使用这两种胫骨假体之一。
治疗性研究，II 级。
