Le Giang Truong, van Duren Bernard Hendrick, Ilo Kevin, Berber Reshid, Matar Hosam E, Bloch Benjamin V
Nottingham Elective Orthopaedic Services Nottingham University Hospitals NHS Trust Nottingham UK.
Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds Leeds UK.
J Exp Orthop. 2024 Jul 15;11(3):e12067. doi: 10.1002/jeo2.12067. eCollection 2024 Jul.
Obesity is prevalent, with nearly one-third of the world's population being classified as obese. In patients with high body mass index (BMI)/body mass undergoing total knee arthroplasty (TKA), there is an increase in strain placed on the implant fixation interfaces. As such, component fixation is a potential concern when performing TKA in the obese patient. To address the growing concerns around the longevity of implant fixation, some have advocated cementless over cemented fixation. However, there is no clear consensus on whether a cementless fixation has more favourable outcomes. The aim of this paper was to present a systematic review and meta-analysis of the existing evidence to establish if cementless TKA has a lower rate of aseptic loosening in high BMI patients when compared to cemented TKA procedures.
A systematic review was performed, and the following databases Medical Literature Analysis and Retrieval System Online (1946 to date), PubMed (1966 to date) and Excerpta Medica Database (1974 to date) were searched. All studies comparing cementless to cemented TKA in patients with BMI > 30 were considered. Meta-analysis compared aseptic loosening and all-cause revision between cemented and uncemented implant use in BMI > 30 patients.
The search returned 91 articles in total; after duplicates were removed, the yield was 44 studies. Of the remaining studies that were assessed, three studies met the inclusion criteria for meta-analysis. The pooled odds ratio for all-cause revisions was 0.17 (95%, 0.08-0.36) in favour of uncemented implants ( < 0.01). The pooled odds ratio for aseptic loosening was 0.15 (95% confidence interval, 0.02-0.90) in favour of uncemented implants ( = 0.04).
Meta-analysis demonstrated a significant decrease in all-cause revisions and revisions for aseptic loosening when using uncemented fixation in high BMI patients when compared to the use of cemented implants.
The level of evidence is 1 for our systematic review.
肥胖十分普遍，全球近三分之一的人口被归类为肥胖。在体重指数（BMI）高/体重较大的患者接受全膝关节置换术（TKA）时，植入物固定界面上的应力会增加。因此，在肥胖患者中进行TKA时，组件固定是一个潜在问题。为了解决人们对植入物固定寿命日益增长的担忧，一些人主张采用非骨水泥固定而非骨水泥固定。然而，对于非骨水泥固定是否具有更有利的结果，目前尚无明确共识。本文的目的是对现有证据进行系统评价和荟萃分析，以确定与骨水泥TKA手术相比，非骨水泥TKA在高BMI患者中无菌性松动率是否更低。
进行了一项系统评价，并检索了以下数据库：医学文献分析和检索系统在线数据库（1946年至今）、PubMed（1966年至今）和医学文摘数据库（1974年至今）。纳入所有比较BMI>30的患者非骨水泥TKA与骨水泥TKA的研究。荟萃分析比较了BMI>30的患者使用骨水泥和非骨水泥植入物时的无菌性松动和全因翻修情况。
检索共返回91篇文章；去除重复项后，得到44项研究。在评估的其余研究中，有3项研究符合荟萃分析的纳入标准。全因翻修的合并比值比为0.17（95%，0.08 - 0.36），支持非骨水泥植入物（P<0.01）。无菌性松动的合并比值比为0.15（95%置信区间，0.02 - 0.90），支持非骨水泥植入物（P = 0.04）。
荟萃分析表明，与使用骨水泥植入物相比，在高BMI患者中使用非骨水泥固定时，全因翻修和无菌性松动翻修显著减少。
我们的系统评价证据水平为1级。
