Almowasafat Hospital, Tripoli, Libya.
Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
Eur J Orthop Surg Traumatol. 2023 Dec;33(8):3611-3622. doi: 10.1007/s00590-023-03594-y. Epub 2023 May 30.
The design of tibial trays for total knee arthroplasty (TKA) has been a topic of research for several decades. Although all-polyethylene trays were developed to address issues such as osteolysis and to enhance the longevity of the prosthesis, as well as knee range of motion, metal-backed designs have remained the most commonly used type of prosthesis. This meta-analysis aimed to compare the clinical, radiological, and survival outcomes of both designs.
Five databases were searched from inception until October 1, 2020, for randomized controlled trials (RCTs) that compared the outcomes of all-polyethylene and metal-backed tibial components in TKA. The outcomes of interest included range of motion, knee society score, stairs climbing scores, radiostereographic analysis, survivorship and complication. This review was conducted in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias was assessed using the Newcastle-Ottawa tool.
A total of 14 RCTs with 1367 TKA were included with a mean age of - years and - years for all-polyethylene and metal-backed tibial components groups, respectively. All-polyethylene group demonstrated statistically significant differences in five-year survivorship (OR 0.27; 95% CI 0.10-0.75; p value 0.01) and stairs climbing score (OR - 2.07; 95% CI - 3.27-0.87; p value 0.0007) when compared to the metal-backed group. The metal-backed design was significantly more radiographically stable in anterior-posterior, varus-valgus, and internal-external rotations at the 2-year follow-up compared to all-polyethylene tibias (OR - 0.09; 95% CI - 0.16 to - 0.02; p value 0.02) as per the pooled radiostereographic analysis. However, ten-year survivorship (OR 0.92; 95% CI 0.53-1.60; p value 0.78), range of motion (OR - 0.57; 95% CI - 2.00-0.85, p value 0.43), knee society scores (OR 1.38; 95% CI - 0.47-3.23, p value 0.14), and complications (OR 0.83; 95% CI 0.5-1.39, p value 0.48) were comparable between both groups.
While this meta-analysis suggests that all-polyethylene tibial components in total knee arthroplasty may offer advantages over metal-backed components in terms of five-year survivorship, and stairs climbing score, this finding should be considered in the context of potential confounding factors. Nonetheless, based on the results, the all-polyethylene implant should be considered a viable choice for primary knee replacement.
I.
全聚乙烯胫骨托在全膝关节置换术（TKA）中的设计一直是研究的课题。尽管全聚乙烯托的开发是为了解决骨溶解等问题，并提高假体的使用寿命和膝关节活动范围，但金属背衬设计仍然是最常用的假体类型。本荟萃分析旨在比较两种设计的临床、影像学和生存结果。
从成立到 2020 年 10 月 1 日，我们在五个数据库中搜索了比较 TKA 中全聚乙烯和金属背衬胫骨组件结果的随机对照试验（RCT）。感兴趣的结果包括活动范围、膝关节协会评分、爬楼梯评分、放射影像学分析、生存率和并发症。本综述符合 PRISMA（系统评价和荟萃分析的首选报告项目）指南。使用纽卡斯尔-渥太华工具评估偏倚风险。
共纳入 14 项 RCT，涉及 1367 例 TKA，平均年龄分别为-岁和-岁，全聚乙烯和金属背衬胫骨组件组。与金属背衬组相比，全聚乙烯组在五年生存率（OR 0.27；95%CI 0.10-0.75；p 值 0.01）和爬楼梯评分（OR -2.07；95%CI -3.27-0.87；p 值 0.0007）方面具有统计学显著差异。在 2 年随访时，金属背衬设计在前-后、内-外翻和内-外旋转方面的影像学稳定性明显优于全聚乙烯胫骨（OR -0.09；95%CI -0.16 至 -0.02；p 值 0.02），根据汇总放射影像学分析。然而，十年生存率（OR 0.92；95%CI 0.53-1.60；p 值 0.78）、活动范围（OR -0.57；95%CI -2.00-0.85，p 值 0.43）、膝关节协会评分（OR 1.38；95%CI -0.47-3.23，p 值 0.14）和并发症（OR 0.83；95%CI 0.5-1.39，p 值 0.48）在两组之间无差异。
虽然这项荟萃分析表明，在全膝关节置换术的五年生存率和爬楼梯评分方面，全聚乙烯胫骨组件可能优于金属背衬组件，但应考虑潜在的混杂因素。尽管如此，根据研究结果，全聚乙烯植入物应被视为初次膝关节置换的可行选择。
I 级。
