Cognault Jeremy, Verdier Nicolas, Hirschmann Michael T
Clinique du Parc, ELSAN, Lyon, France.
Service orthopédie, Polyclinique Jean-Villar, ELSAN, Bruges, France.
Knee Surg Sports Traumatol Arthrosc. 2024 Dec 4. doi: 10.1002/ksa.12545.
This umbrella review aimed to identify, synthesise and critically appraise the findings of meta-analyses that compare adverse events-rates of complications, reoperations and revisions-following total knee arthroplasty (TKA) using unrestricted kinematic alignment versus mechanical alignment.
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, two authors independently screened articles based on inclusion and exclusion criteria, and assessed the methodological quality based on the 16 domains of A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2). Effect sizes of difference in rates of complications were tabulated for each meta-analysis. Studies included in the meta-analyses were assessed to determine if they were on true unrestricted kinematic alignment. A secondary meta-analysis was performed, excluding studies on restricted kinematic alignment techniques, to calculate pooled estimates of adverse events (odds ratio [OR] with its 95% confidence interval [CI]) in a common effects framework with inverse-variance weighting.
Of 78 potential records, 13 meta-analyses were eligible for data extraction, which pooled data from 15 clinical studies (10 on unrestricted kinematic alignment, four on restricted kinematic alignment and one on inverse kinematic alignment). None of the meta-analyses fulfilled all seven critical AMSTAR-2 domains. Meta-analyses categorised adverse events differently and used different measures for the effect sizes but revealed no differences between kinematic versus mechanical alignment. Exclusion of studies on restricted kinematic alignment techniques reduced total sample sizes for kinematic alignment from 658 to 318 and for mechanical alignment from 811 to 403. Secondary meta-analyses exclusively on unrestricted kinematic alignment revealed no difference in complications without reoperation, reoperation without implant removal or reoperation with implant removal following kinematic versus mechanical alignment.
Meta-analyses do not distinguish between various kinematic alignment techniques, and adverse events are compared using different metrics. Surgeons, researchers and editors should refrain from pooling data on various kinematic alignment techniques, and orthopaedic societies should promote standards for reporting adverse events and effect sizes to facilitate comparisons across future studies.
Level III.
本综合评价旨在识别、综合并批判性评价 Meta 分析的结果，这些 Meta 分析比较了使用无限制运动学对线与机械对线进行全膝关节置换术（TKA）后并发症、再次手术和翻修的不良事件发生率。
根据系统评价和 Meta 分析的首选报告项目标准，两位作者独立根据纳入和排除标准筛选文章，并根据评估系统评价的测量工具（AMSTAR-2）的 16 个领域评估方法学质量。对每项 Meta 分析列出并发症发生率差异的效应量。评估纳入 Meta 分析的研究，以确定它们是否采用真正的无限制运动学对线。进行了一项二次 Meta 分析，排除了关于受限运动学对线技术的研究，以在具有逆方差加权的共同效应框架中计算不良事件的合并估计值（比值比[OR]及其 95%置信区间[CI]）。
在 78 条潜在记录中，13 项 Meta 分析符合数据提取条件，这些分析汇总了 15 项临床研究的数据（10 项关于无限制运动学对线，4 项关于受限运动学对线，1 项关于逆向运动学对线）。没有一项 Meta 分析满足 AMSTAR-2 的所有七个关键领域。Meta 分析对不良事件的分类不同，对效应量使用不同的测量方法，但未显示运动学对线与机械对线之间存在差异。排除关于受限运动学对线技术的研究后，运动学对线的总样本量从 658 减少到 318，机械对线的总样本量从 811 减少到 403。仅针对无限制运动学对线的二次 Meta 分析显示，运动学对线与机械对线在无再次手术的并发症、无植入物取出的再次手术或有植入物取出的再次手术方面没有差异。
Meta 分析未区分各种运动学对线技术，且使用不同指标比较不良事件。外科医生、研究人员和编辑应避免汇总各种运动学对线技术的数据，骨科协会应推广不良事件和效应量报告标准，以促进未来研究之间的比较。
三级。
