Yao Kaiyi, Chen Yao
Faculty of Medicine and Health Sciences Ghent University Ghent Belgium.
Department of Applied Mathematics, Computer Science and Statistics Ghent University Ghent Belgium.
J Exp Orthop. 2024 Jul 21;11(3):e12095. doi: 10.1002/jeo2.12095. eCollection 2024 Jul.
Aseptic loosening is the most common cause for revisions after total knee arthroplasty (TKA). Despite many studies exploring various risk factors associated with aseptic loosening, findings often present inconsistencies. To address this, we conducted a thorough review of the literature to identify and analyse these risk factors in cemented TKA. Additionally, we performed a meta-analysis to reconcile the divergent conclusions observed across studies.
We searched PubMed, Web of Science and Embase from 1996 up to 2024 and evaluated the quality of the included literature. Seventy-four studies were included to assess the association of BMI, diabetes, high physical activity (HPA), osteoporosis, rheumatoid arthritis (RA), cement material and implant design. Twenty-nine studies were used to calculate relative risk and CIs (using the random effects theory) and study heterogeneity for six different risk factors (BMI, diabetes, HPA level, cement material, polyethylene and implant design).
Patients with diabetes are eight times more likely to experience aseptic loosening compared to those without diabetes (RR = 9.18, 95% CI: 1.80-46.77, < 0.01). The use of tibial stem extension or highly crosslinked polyethylene can help reduce the incidence of aseptic loosening. However, we did not identify BMI, HPA, osteoporosis, RA, the use of high-viscosity cement and the utilization of mobile-bearing designs as risk factors for aseptic loosening post-cemented TKA.
Patients with diabetes undergoing TKA should be counselled regarding their potential increased risk of aseptic loosening. The use of tibial stem extensions and HXLPE can mitigate the incidence of aseptic loosening in cemented TKA. However, given a limited number of studies were included in the meta-analysis, we believe that higher-level studies are necessary to clearly identify other risk factors.
Level III.
无菌性松动是全膝关节置换术（TKA）后翻修的最常见原因。尽管有许多研究探讨了与无菌性松动相关的各种风险因素，但研究结果往往存在不一致性。为解决这一问题，我们对文献进行了全面回顾，以识别和分析骨水泥型TKA中的这些风险因素。此外，我们进行了一项荟萃分析，以协调各研究中观察到的不同结论。
我们检索了1996年至2024年的PubMed、Web of Science和Embase，并评估了纳入文献的质量。纳入74项研究以评估体重指数（BMI）、糖尿病、高体力活动（HPA）、骨质疏松症、类风湿性关节炎（RA）、骨水泥材料和植入物设计之间的关联。29项研究用于计算相对风险和可信区间（使用随机效应理论），并研究六个不同风险因素（BMI、糖尿病、HPA水平、骨水泥材料、聚乙烯和植入物设计）的研究异质性。
与无糖尿病患者相比，糖尿病患者发生无菌性松动的可能性高八倍（RR = 9.18，95% CI：1.80 - 46.77，P < 0.01）。使用胫骨柄延长术或高度交联聚乙烯有助于降低无菌性松动的发生率。然而，我们未发现BMI、HPA、骨质疏松症、RA、使用高粘度骨水泥和采用活动平台设计是骨水泥型TKA后无菌性松动的风险因素。
对于接受TKA的糖尿病患者，应告知其无菌性松动风险可能增加。使用胫骨柄延长术和高交联聚乙烯（HXLPE）可降低骨水泥型TKA中无菌性松动的发生率。然而，鉴于荟萃分析中纳入的研究数量有限，我们认为需要更高级别的研究来明确识别其他风险因素。
三级。
