Stem fixation techniques in revision total knee arthroplasty: A systematic review and meta-analysis.

PURPOSE

This systematic review and meta-analysis aimed to compare the clinical and radiological outcomes of patients undergoing revision total knee arthroplasty (rTKA) using uncemented press-fit stems (hybrid fixation) versus cemented stems (cemented fixation). It is also examined whether cemented fixation offers any superiority over hybrid fixation regarding implant survival, clinical function, imaging analysis and complication rates.

METHODS

Following the PRISMA guidelines, a systematic review and meta-analysis were conducted on five databases (Pubmed, Scopus, Embase, Medline and Cochrane). Articles were evaluated according to levels of evidence (LoE). Retrospective studies were analysed with risk of bias in nonrandomised studies of interventions (Robins-I) and randomised controlled trials with risk of bias 2 (RoB-2). This review was registered in the International Prospective Register of Systematic Reviews database. Meta-analysis was performed using R software, with  < 0.05 considered statistically significant.

RESULTS

Data from 12 comparative studies with 1303 patients (1352 rTKAs) were analysed. Survival rates of hybrid and cemented fixations were comparable, with a significant trend favouring hybrid fixation ( = 0.04). Infection and aseptic loosening were the most common causes of failure. Radiographic failure rates showed no significant differences between fixation methods ( = 0.4). Meta-analysis indicated better results with hybrid fixation, although not statistically significant (KSS functional  = 0.15; KSS clinical  = 0.5). High heterogeneity was observed due to variations in patient characteristics and surgical strategies.

CONCLUSION

Both hybrid and cemented fixation techniques achieve satisfactory clinical results in rTKA, with hybrid fixation demonstrating an overall lower failure rate. The choice of fixation method must be tailored to individual patient characteristics and surgical considerations. Further high-quality randomised trials are needed to refine these results and optimise fixation strategies to improve patient outcomes.

LEVEL OF EVIDENCE

Level IV.