Zheng Yuhang, Li Yang, Yuan Ziqi, Geng Xiao, Tian Hua
Department of Orthopedics Peking University Third Hospital Beijing China.
Engineering Research Center of Bone and Joint Precision Medicine Ministry of Education Beijing China.
J Exp Orthop. 2024 Nov 28;11(4):e70098. doi: 10.1002/jeo2.70098. eCollection 2024 Oct.
Various assistive techniques, such as conventional cutting instruments (CON), computer-assisted navigation systems (CAS), patient-specific instruments (PSI) and robot-assisted systems (RAS), have been developed and applied in primary total knee arthroplasty (TKA). In this study, we aimed to assess the relative accuracy and efficacy of several assistive techniques for TKA through a network meta-analysis (NMA) based on multiple published randomized controlled trials (RCTs).
The PubMed, EMBASE and Cochrane databases were searched for RCTs to conduct this NMA from inception to 1 January 2024. We combined direct and indirect comparisons using a Bayesian NMA framework to assess and compare the effects of different assistive techniques on radiological and clinical outcomes. An NMA was conducted, and the study protocol was published online at PROSPERO (CRD42023402882).
One hundred and twelve RCTs involving 14,968 TKAs with four different assistive techniques (CON, CAS, PSI and RAS) were evaluated. Inconsistency and heterogeneity were acceptable for most outcomes. Based on the surface under the cumulative ranking curve, RAS could be the best technique for accurate mechanical axis alignment and component position, followed by CAS, PSI and CON. We observed no difference in clinical outcome scores. Additionally, CAS was the best intervention for visual analogue scale scores, and PSI had the shortest operative time. No significant differences were observed in postoperative complications, range of motion or total blood loss.
RAS was most likely to achieve an accurate alignment, followed by CAS, PSI and CON. No differences were observed in clinical outcome scores and postoperative complications among the four assistive techniques.
Level I (systematic review of Level-I randomized controlled studies).
各种辅助技术，如传统切割器械（CON）、计算机辅助导航系统（CAS）、患者特异性器械（PSI）和机器人辅助系统（RAS），已被开发并应用于初次全膝关节置换术（TKA）。在本研究中，我们旨在通过基于多项已发表的随机对照试验（RCT）的网络荟萃分析（NMA），评估几种TKA辅助技术的相对准确性和疗效。
检索PubMed、EMBASE和Cochrane数据库中的RCT，以进行本NMA，检索时间从建库至2024年1月1日。我们使用贝叶斯NMA框架合并直接和间接比较，以评估和比较不同辅助技术对放射学和临床结果的影响。进行了NMA，研究方案已在PROSPERO（CRD42023402882）上在线发表。
评估了112项RCT，涉及14968例接受四种不同辅助技术（CON、CAS、PSI和RAS）的TKA。大多数结果的不一致性和异质性是可接受的。根据累积排序曲线下面积，RAS可能是实现准确机械轴对线和假体位置的最佳技术，其次是CAS、PSI和CON。我们观察到临床结果评分没有差异。此外，CAS是视觉模拟量表评分的最佳干预措施，PSI的手术时间最短。术后并发症、活动范围或总失血量方面未观察到显著差异。
RAS最有可能实现准确对线，其次是CAS、PSI和CON。四种辅助技术在临床结果评分和术后并发症方面没有差异。
I级（I级随机对照研究的系统评价）。
