Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.
Knee Surg Sports Traumatol Arthrosc. 2022 Sep;30(9):3138-3154. doi: 10.1007/s00167-022-07065-5. Epub 2022 Jul 21.
Both mobile (MB) and fixed (FB) bearing implants are routinely used for total knee arthroplasty (TKA). This meta-analysis compared MB versus FB for TKA in terms of implant positioning, joint function, patient reported outcome measures (PROMs), and complications. It was hypothesised that MB performs better than FB implants in primary TKA.
This meta-analysis was conducted according to the 2020 PRISMA statement. In February 2022, the following databases were accessed: Pubmed, Web of Science, Google Scholar, Embase. All the randomized clinical trials (RCTs) comparing mobile versus fixed bearing for primary TKA were considered.
Data from 74 RCTs (11,116 procedures) were retrieved. The mean follow-up was 58.8 (7.5 to 315.6) months. The MB group demonstrated greater range of motion (ROM) (P = 0.02), Knee Society Score (KSS) score (P < 0.0001), and rate of deep infections (P = 0.02). No difference was found in implant positioning: tibial slope, delta angle, alpha femoral component angle, gamma femoral component angle, beta tibial component angle, tibiofemoral alignment angle, posterior condylar offset, radiolucent lines. No difference was found in duration of the surgical procedure. No difference was found in the following PROMs: Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), function and pain subscales of the KSS score. No difference was found in the rate of anterior knee pain, revision, aseptic loosening, fractures, and deep vein thrombosis.
There is no evidence in support that MB implants promote greater outcomes compared to FB implants in primary TKA.
Level I.
在全膝关节置换术（TKA）中，经常使用移动（MB）和固定（FB）轴承植入物。本荟萃分析比较了 MB 与 FB 在植入物定位、关节功能、患者报告的结果测量（PROMs）和并发症方面的 TKA。假设 MB 在原发性 TKA 中的表现优于 FB 植入物。
本荟萃分析根据 2020 年 PRISMA 声明进行。2022 年 2 月，检索了以下数据库：Pubmed、Web of Science、Google Scholar、Embase。所有比较原发性 TKA 中移动与固定轴承的随机对照试验（RCT）均被考虑。
共检索到 74 项 RCT（11116 例）的数据。平均随访时间为 58.8（7.5 至 315.6）个月。MB 组表现出更大的关节活动度（ROM）（P=0.02）、膝关节学会评分（KSS）评分（P<0.0001）和深部感染率（P=0.02）。在植入物定位方面，胫骨斜率、Delta 角、股骨组件 alpha 角、股骨组件 gamma 角、胫骨组件 beta 角、胫股对线角度、后髁间偏移、透光线无差异。手术时间无差异。以下 PROMs 无差异：牛津膝关节评分（OKS）、安大略西部和麦克马斯特大学骨关节炎指数（WOMAC）、视觉模拟量表（VAS）、KSS 评分的功能和疼痛子量表。在膝关节前痛、翻修、无菌性松动、骨折和深静脉血栓形成的发生率方面无差异。
没有证据支持 MB 植入物在原发性 TKA 中比 FB 植入物能带来更好的结果。
一级。
