内侧旋转平台设计与传统假体在初次全膝关节置换中的比较：一项随机对照试验的系统评价和荟萃分析。
Medial Pivot Designs Versus Conventional Bearing Types in Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
机构信息
From the Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia (Dr. Hoskins); Traumaplasty Melbourne, East Melbourne, Australia (Dr. Hoskins); the Department of Orthopaedics, Northland District Health Board, Whangarei, New Zealand (Dr. Hoskins, Smith, and Dr. Vince); and Department of Surgery, St. Vincent's Hospital, the University of Melbourne, Melbourne, Australia (Dr. Spelman).
出版信息
J Am Acad Orthop Surg Glob Res Rev. 2022 Dec 5;6(12). doi: 10.5435/JAAOSGlobal-D-22-00170. eCollection 2022 Dec 1.
BACKGROUND
Medial pivot (MP) designs are growing in popularity. They provide increased sagittal plane stability and theoretically replicate some aspects of native joint kinematics, which may improve total knee arthroplasty outcomes.
METHODS
A systematic review was performed of randomized controlled trials (RCTs) that compared MP designs with cruciate-retaining, posterior-stabilized (PS), ultracongruent, or mobile-bearings in primary total knee arthroplasty, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome measures were all clinical function scores, patient-reported outcome measures, and range of motion. The secondary outcome was complications. Two authors independently selected studies, performed data extraction, and risk-of-bias assessment. Studies at high risk of bias were excluded from meta-analysis. Treatment effects were assessed using random-effects meta-analysis and quantified using pooled mean differences or incidence rate differences as appropriate.
RESULTS
Eight RCTs met inclusion criteria. Five compared MP with PS, two with ultracongruent, and one with cruciate-retaining and mobile-bearing. In total, 350 knees were randomized to MP and 375 to conventional bearings. One RCT was excluded from meta-analysis because of high risk of bias. Meta-analysis comparing MP with PS only was possible and found no differences at any time points for any outcome measure, including 2-year follow-up for Oxford Knee Score (MD = 0.35 favoring PS; 95% CI -0.49 to 1.20) and range of motion (MD = 1.58 favoring MP; 95% CI -0.76 to 11.92, P = 0.30) and 12 months for Western Ontario Arthritis Index (MD = 4.42 favoring MP; 95% CI -12.04 to 3.20, P = 0.09).
CONCLUSIONS
There is no difference in clinical outcomes, with contemporary measurement tools, at any time points, between MP and PS. There are insufficient RCTs comparing MP with other bearings.
背景
内侧枢轴（MP）设计越来越受欢迎。它们提供了增加矢状面稳定性，并在理论上复制了一些天然关节运动学的方面，这可能会改善全膝关节置换术的结果。
方法
根据系统评价和荟萃分析的首选报告项目指南，对比较 MP 设计与保留交叉韧带、后稳定（PS）、超共面或活动衬垫的随机对照试验（RCT）进行了系统评价。主要结局测量指标是所有临床功能评分、患者报告的结局测量指标和活动范围。次要结局是并发症。两位作者独立选择研究、进行数据提取和风险偏倚评估。高风险偏倚的研究被排除在荟萃分析之外。使用随机效应荟萃分析评估治疗效果，并根据需要使用汇总平均差异或发病率差异来量化。
结果
八项 RCT 符合纳入标准。五项比较 MP 与 PS，两项比较超共面，一项比较保留交叉韧带和活动衬垫。共有 350 个膝关节随机分配到 MP 组，375 个膝关节分配到常规轴承组。一项 RCT 因高风险偏倚而被排除在荟萃分析之外。仅比较 MP 与 PS 的荟萃分析是可能的，并且在任何时间点都没有发现任何结局测量指标的差异，包括牛津膝关节评分的 2 年随访（MD=0.35，PS 组更优；95%CI-0.49 至 1.20）和活动范围（MD=1.58，MP 组更优；95%CI-0.76 至 11.92，P=0.30）和 Western Ontario 关节炎指数 12 个月（MD=4.42，MP 组更优；95%CI-12.04 至 3.20，P=0.09）。
结论
在任何时间点，使用现代测量工具，MP 和 PS 在临床结局方面都没有差异。比较 MP 与其他轴承的 RCT 还不够。
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