Shekhar Adithya, Dungy Danton, Stewart Susan L, Jamali Amir A
Joint Preservation Institute, Walnut Creek, CA, USA.
The Dungy Orthopedic Center, Chandler, AZ, USA.
Arthroplast Today. 2023 Apr 25;21:101127. doi: 10.1016/j.artd.2023.101127. eCollection 2023 Jun.
Total knee arthroplasty (TKA) is an effective treatment method for severe osteoarthritis of the knee. Poor alignment of a knee replacement has been associated with suboptimal clinical results. Traditionally, mechanical alignment (MA) has been considered the gold standard. In light of reports of decreased satisfaction with TKA, a new technique called kinematic alignment (KA) has been developed. The purpose of this study is to (1) review the results of KA and MA for TKA in randomized controlled trials based on the Western Ontario and McMaster Universities Arthritis Index score, the Oxford Knee Score, and the Knee Society Scores, (2) perform a meta-analyses of the randomized controlled trials with baseline and follow-up values of these parameters, and (3) discuss other shortcomings of this literature from the perspective of study design and execution.
Two independent reviewers performed a systematic review of the English literature using the Embase, Scopus, and PubMed databases searching for randomized controlled trials of MA vs KA in TKA. Of the initial 481 published reports, 6 studies were included in the final review for meta-analysis. The individual studies were then analyzed to evaluate for risks of bias and inconsistencies of methodology.
A majority of studies demonstrated low risk of bias. All studies had fundamental technical issues by utilizing different techniques to achieve KA vs MA. There was no significant difference between KA and MA in these studies.
There is no significant difference in any outcomes measured between KA and MA in TKA. Both statistical and methodological factors diminish the value of these conclusions.
全膝关节置换术（TKA）是治疗重度膝关节骨关节炎的有效方法。膝关节置换术的对线不佳与临床效果不理想有关。传统上，机械对线（MA）一直被视为金标准。鉴于对TKA满意度下降的报道，一种名为运动学对线（KA）的新技术应运而生。本研究的目的是：（1）基于西安大略和麦克马斯特大学关节炎指数评分、牛津膝关节评分和膝关节协会评分，回顾随机对照试验中TKA的KA和MA结果；（2）对这些参数的基线值和随访值进行随机对照试验的荟萃分析；（3）从研究设计和实施的角度讨论该文献的其他不足之处。
两名独立 reviewers 使用 Embase、Scopus 和 PubMed 数据库对英文文献进行系统回顾，搜索 TKA 中 MA 与 KA 的随机对照试验。在最初发表的481篇报告中，6项研究被纳入最终回顾以进行荟萃分析。然后对各个研究进行分析，以评估偏倚风险和方法学的不一致性。
大多数研究显示偏倚风险较低。所有研究在实现 KA 与 MA 时都存在基本的技术问题。在这些研究中，KA 和 MA 之间没有显著差异。
TKA 中 KA 和 MA 之间在任何测量结果上均无显著差异。统计和方法学因素均降低了这些结论的价值。
