Department of Joint Surgery, 594331North China Medical&Health Group XingTai General Hospital, Hebei, China.
J Orthop Surg (Hong Kong). 2022 Sep-Dec;30(3):10225536221125952. doi: 10.1177/10225536221125952.
The purpose of this meta-analysis was to compare the efficacy and imaging parameters of kinematic alignment (KA) and mechanical alignment (MA) in total knee arthroplasty (TKA) and to evaluate whether patients undergoing KA-TKA benefited more than those undergoing MA-TKA.
Studies comparing the efficacy of KA-TKA and MA-TKA were included after searching and screening in the database, including PubMed, Embase, Web of Science and Cochrane Database Library. A total of 1420 patients were enrolled in the study, with 736 MA-TKA and 738 KA-TKA. The primary outcomes were postoperative knee function scores including KSS series, WOMAC, KOOS and OKS. Secondary outcomes included the operative time, the length of hospital stay, knee extension/flexion angle, and some imaging parameters. The risk of bias for included studies was assessed using the Cochrane Collaborative risk-of-bias assessment tool or the Newcastle-Ottawa Scale(NOS).
Sixteen studies were included in this meta-analysis (11 randomized controlled studies and 5 cohort studies). Primary outcomes: Knee Society score (KSS, MD = 8.36, 95% Cl: 0.83-15.90) and combined KSS (MD = 15.24, 95% CI: 5.41-25.07) were higher in KA-TKA than in MA-TKA, and other functional scores were not statistically significant in KA-TKA and MA-TKA, including knee injury and osteoarthritis outcome score (KOOS), Oxford knee score (OKS), Knee Function score (KFS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes: KA-TKA resulted in smaller medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA) compared to MA-TKA. For other outcome measures, KA-TKA showed similar results compared to MA-TKA, including hip-knee-ankle (HKA) angle, extension/flexion angle, tibial component slope angle, joint line orientation angle (JLOA), the operation time, the length of hospital stay and ligament release rate.
In our analysis results, patients undergoing KA-TKA benefit as much as patients undergoing MA-TKA. KA may be a viable reference in total knee replacement.
本荟萃分析旨在比较运动学对线（KA）和机械对线（MA）在全膝关节置换术（TKA）中的疗效和影像学参数，并评估行 KA-TKA 的患者是否比行 MA-TKA 的患者获益更多。
通过在数据库中搜索和筛选，包括 PubMed、Embase、Web of Science 和 Cochrane 数据库图书馆，纳入比较 KA-TKA 和 MA-TKA 疗效的研究。共纳入 1420 例患者，其中 736 例行 MA-TKA，738 例行 KA-TKA。主要结局包括术后膝关节功能评分，包括 KSS 系列、WOMAC、KOOS 和 OKS。次要结局包括手术时间、住院时间、膝关节伸直/屈曲角度和一些影像学参数。使用 Cochrane 协作风险偏倚评估工具或纽卡斯尔-渥太华量表（NOS）评估纳入研究的偏倚风险。
本荟萃分析纳入了 16 项研究（11 项随机对照研究和 5 项队列研究）。主要结局：KA-TKA 的膝关节协会评分（KSS，MD=8.36，95%Cl：0.83-15.90）和综合 KSS（MD=15.24，95%CI：5.41-25.07）高于 MA-TKA，其他功能评分在 KA-TKA 和 MA-TKA 中均无统计学意义，包括膝关节损伤和骨关节炎结局评分（KOOS）、牛津膝关节评分（OKS）、膝关节功能评分（KFS）和西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）。次要结局：与 MA-TKA 相比，KA-TKA 导致更小的内侧近端胫骨角（MPTA）和外侧远端股骨角（LDFA）。对于其他结局测量，KA-TKA 与 MA-TKA 相比显示出相似的结果，包括髋膝踝（HKA）角、伸直/屈曲角度、胫骨组件斜率角度、关节线定向角（JLOA）、手术时间、住院时间和韧带松解率。
在我们的分析结果中，行 KA-TKA 的患者与行 MA-TKA 的患者获益相当。KA 可能是全膝关节置换术的一种可行参考。
