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混合固定与骨水泥固定假体的系统评价和荟萃分析-哪种方法在翻修全膝关节置换术中更优？

A systematic review and meta-analysis of hybrid vs. cemented stems - which method is more optimal for revision total knee arthroplasty?

机构信息

Department of Orthopaedic Surgery, Changi General Hospital, 2 Simei St 3, Simei, 529889, Singapore.

出版信息

BMC Musculoskelet Disord. 2024 Apr 10;25(1):277. doi: 10.1186/s12891-024-07389-y.

DOI:10.1186/s12891-024-07389-y
PMID:38600536
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11005209/
Abstract

INTRODUCTION

The number of primary and revision Total Knee Arthroplasty (TKA) cases are expected to increase in future. There are various advantages and disadvantage to employing either of the two main types of stem fixation methods - cemented or hybrid technique. This review aimed to study the most optimal fixation method for revision TKAs by comparing radiological outcomes and re-revision rates.

METHODS

A systematic review and meta-analysis was performed using PubMed and Cochrane Library from 2010 to identify studies explicitly comparing outcomes between cemented against hybrid fixation revision TKA techniques, with a minimum follow up of at least 24 months. A total of 8 studies was included in this review. Egger's test and visual inspection of the funnel plot did not reveal publication bias.

RESULTS

There was no statistically significant difference in radiological failure and loosening (OR 0.79, CI 0.37-1.66, I = 29%, p = 0.22), all causes of re-revision (OR 1.03, CI 0.73-1.44, I = 0%, p = 0.56) and aseptic revision (OR 0.74, CI 0.27-2.02, I = 0%, p = 0.41) between cemented and hybrid techniques. Functional and pain outcomes compared between the two fixation techniques were largely similar across the studies included in this meta-analysis.

CONCLUSION

Despite a trend favouring hybrid stems in revision TKA, current evidence revealed that radiological outcomes and re-revision rates are largely similar between cemented and hybrid fixation techniques.

摘要

简介

预计未来初次全膝关节置换术（TKA）和翻修 TKA 的数量将会增加。使用两种主要的柄固定方法（骨水泥型或混合技术）各有优缺点。本研究旨在通过比较影像学结果和再次翻修率来研究翻修 TKA 中最理想的固定方法。

方法

使用 PubMed 和 Cochrane Library 进行了系统的回顾和荟萃分析，以确定明确比较骨水泥型与混合固定翻修 TKA 技术之间结果的研究，最低随访时间至少为 24 个月。本综述共纳入 8 项研究。Egger 检验和漏斗图的视觉检查均未发现发表偏倚。

结果

在影像学失败和松动（OR 0.79，CI 0.37-1.66，I = 29%，p = 0.22）、所有原因的再次翻修（OR 1.03，CI 0.73-1.44，I = 0%，p = 0.56）和无菌性翻修（OR 0.74，CI 0.27-2.02，I = 0%，p = 0.41）方面，骨水泥型和混合技术之间没有统计学意义上的差异。在纳入本荟萃分析的研究中，两种固定技术之间的功能和疼痛结果基本相似。

结论

尽管翻修 TKA 中混合柄有趋势，但现有证据表明，骨水泥型和混合固定技术的影像学结果和再次翻修率基本相似。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fb6/11005209/401af7867ab8/12891_2024_7389_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fb6/11005209/33f3c49b67b6/12891_2024_7389_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fb6/11005209/68eecfcc5338/12891_2024_7389_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fb6/11005209/04f5396418b6/12891_2024_7389_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fb6/11005209/aa4fd8e7035c/12891_2024_7389_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fb6/11005209/a0a1a420c314/12891_2024_7389_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fb6/11005209/aa85d679ab05/12891_2024_7389_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fb6/11005209/401af7867ab8/12891_2024_7389_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fb6/11005209/33f3c49b67b6/12891_2024_7389_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fb6/11005209/68eecfcc5338/12891_2024_7389_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fb6/11005209/04f5396418b6/12891_2024_7389_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fb6/11005209/aa4fd8e7035c/12891_2024_7389_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fb6/11005209/a0a1a420c314/12891_2024_7389_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fb6/11005209/aa85d679ab05/12891_2024_7389_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fb6/11005209/401af7867ab8/12891_2024_7389_Fig7_HTML.jpg

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