Stroobant Lenka, de Taeye Thijmen, Byttebier Paul, Van Onsem Stefaan, Jacobs Ewoud, Burssens Arne, Victor Jan
Department Orthopaedic Surgery, University Hospital Ghent, Ghent, Belgium.
Department Orthopaedic Surgery, ASZ Aalst, Aalst, Belgium.
Knee Surg Sports Traumatol Arthrosc. 2023 Dec;31(12):5365-5380. doi: 10.1007/s00167-023-07572-z. Epub 2023 Sep 25.
In revision total knee arthroplasty (TKA) ligament instability and bone defects might require more constraint implants such as a condylar constrained knee (CCK) or rotating hinged knee (RHK). When both implants are suitable, the choice remains controversial. The purpose of this systematic review and meta-analysis was to compare the survivorship and clinical outcome between CCK and RHK in revision TKA.
Systematic literature research was performed. Studies analysing the clinical outcome and/or survivorship of CCK and/or RHK in revision TKA were included. Clinical outcomes included the Knee Society Score, both clinical (KSCS) and functional (KSFS), range of motion (ROM) and reoperations. Survival was defined as the time free from removal or revision of the femoral and/or tibial component.
A total of 40 articles analysing 4.555 knees were included. Survival did not differ between RHK and CCK implants (p = 0.6058), with, respectively, 91.6% and 89.8% survival after 5 years. Postoperative KSCS and KSFS were, respectively, 79.2 (SD 10.7) and 61.1 (SD 21.8) for the CCK group. Similar scores were noted for the RHK group with a KSCS of 80.2 (SD 14.1) and KSFS of 58.5 (SD 17.3). Postoperative ROM was similar for CCK (105.3°, SD 17.1°) and RHK patients (104.1°, SD 16.9°).
This meta-analysis revealed that both survivorship and clinical outcome are similar for CCK and RHK patients for whom both designs are technically suitable and indicated.
IV.
在全膝关节置换翻修术（TKA）中，韧带不稳定和骨缺损可能需要使用更多限制性植入物，如髁限制性膝关节（CCK）或旋转铰链膝关节（RHK）。当两种植入物都适用时，选择仍存在争议。本系统评价和荟萃分析的目的是比较CCK和RHK在TKA翻修术中的生存率和临床结局。
进行系统的文献研究。纳入分析CCK和/或RHK在TKA翻修术中临床结局和/或生存率的研究。临床结局包括膝关节协会评分，包括临床评分（KSCS）和功能评分（KSFS）、活动范围（ROM）和再次手术情况。生存率定义为股骨和/或胫骨组件未被取出或翻修的时间。
共纳入40篇分析4555例膝关节的文章。RHK和CCK植入物的生存率无差异（p = 0.6058），5年后生存率分别为91.6%和89.8%。CCK组术后KSCS和KSFS分别为79.2（标准差10.7）和61.1（标准差21.8）。RHK组的评分相似，KSCS为80.2（标准差14.1），KSFS为58.5（标准差17.3）。CCK患者（105.3°，标准差17.1°）和RHK患者（104.1°，标准差16.9°）术后ROM相似。
本荟萃分析表明，对于两种设计在技术上都适用且有指征的CCK和RHK患者，其生存率和临床结局相似。
IV级。
