Tsai Yen-Lin, Tsai Sung Huang Laurent, Lin Chia-Han, Lin Chun-Ru, Hu Chih-Chien
Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fu-Hsin St. Kweishan County, Taoyuan 333, Taiwan.
Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fu-Hsin St. Kweishan County, Taoyuan 333, Taiwan.
Life (Basel). 2023 Sep 21;13(9):1942. doi: 10.3390/life13091942.
: The aim of this study was to determine whether modern congruent tibial inserts are associated with superior outcomes in total knee arthroplasty (TKA). : Ultracongruent fixed-bearing (UCFB) and medial congruent fixed-bearing (MCFB) inserts have been known to be effective in total knee arthroplasty with patient satisfaction. Nonetheless, no supporting evidence to date exists to rank the clinical outcomes of these various congruent inserts in TKA compared with other important considerations in TKA including cruciate-retaining fixed-bearing (CRFB) and posterior-stabilized fixed-bearing (PSFB) inserts. : We searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and Scopus up to 15 May 2022. We selected studies involving an active comparison of UCFB or MCFB in TKAs. We performed a network meta-analysis (NMA) of randomized controlled trials (RCTs) and compared different congruent inserts. We ranked the clinical outcomes by SUCRA score with the estimate of the best treatment probability. Our primary outcomes were revision rates and radiolucent lines. Secondary outcomes were functional scores, including the range of motion (ROM), the Knee Society Score (KSS), the Oxford Knee Score (OKS), and WOMAC. : Eighteen RCTs with 1793 participants were analyzed. Our NMA ranked MCFB, CRFB, and UCFB with the lowest revision rates. CRFB and UCFB had the fewest radiolucent lines. UCFB had overall the best ROM. UCFB and MCFB had the best OKS score overall. : The ranking probability for better clinical outcomes in congruent inserts demonstrated the superiority of congruent tibial inserts, including UCFB and MCFB. UCFB may be associated with better ROM and postoperative functional outcomes. However, integrating future RCTs for high-level evidence is necessary to confirm these findings.
本研究的目的是确定现代全膝关节置换术（TKA）中使用的匹配胫骨假体是否能带来更好的治疗效果。超匹配固定平台（UCFB）和内侧匹配固定平台（MCFB）假体在全膝关节置换术中已被证明是有效的，患者满意度较高。然而，与全膝关节置换术的其他重要因素相比，包括保留交叉韧带固定平台（CRFB）和后稳定固定平台（PSFB）假体，目前尚无支持证据来对这些不同匹配假体在全膝关节置换术中的临床效果进行排序。我们检索了截至2022年5月15日的PubMed、Embase、Cochrane对照试验中央注册库、Web of Science和Scopus。我们选择了涉及在全膝关节置换术中对UCFB或MCFB进行主动比较的研究。我们对随机对照试验（RCT）进行了网络荟萃分析（NMA），并比较了不同的匹配假体。我们通过SUCRA评分和最佳治疗概率估计对临床效果进行排序。我们的主要结局指标是翻修率和透光线。次要结局指标是功能评分，包括活动范围（ROM）、膝关节协会评分（KSS）、牛津膝关节评分（OKS）和WOMAC。对18项随机对照试验中的1793名参与者进行了分析。我们的网络荟萃分析将MCFB、CRFB和UCFB排在翻修率最低的位置。CRFB和UCFB的透光线最少。UCFB总体上具有最佳的活动范围。UCFB和MCFB总体上具有最佳的牛津膝关节评分。匹配假体在更好临床效果方面的排序概率表明了包括UCFB和MCFB在内的匹配胫骨假体的优越性。UCFB可能与更好的活动范围和术后功能结局相关。然而，需要纳入未来的随机对照试验以获得高级别证据来证实这些发现。
