Onorato Francesco, Giai Via Riccardo, Bosco Francesco, Lavia Alessandro Dario, Barberis Luca, Capella Marcello, Massè Alessandro, Risitano Salvatore
Department of Orthopaedics, Traumatology and Rehabilitation University of Turin Turin Italy.
Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.) University of Palermo Palermo Italy.
J Exp Orthop. 2025 Jan 9;12(1):e70086. doi: 10.1002/jeo2.70086. eCollection 2025 Jan.
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.
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.
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.
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 IV.
本系统评价和荟萃分析旨在比较采用非骨水泥压配型柄（混合固定）与骨水泥柄（骨水泥固定）进行翻修全膝关节置换术（rTKA）患者的临床和影像学结果。此外，还研究了在植入物生存率、临床功能、影像学分析和并发症发生率方面，骨水泥固定是否比混合固定具有任何优势。
按照PRISMA指南，对五个数据库（PubMed、Scopus、Embase、Medline和Cochrane）进行系统评价和荟萃分析。根据证据水平（LoE）对文章进行评估。回顾性研究采用干预性非随机研究的偏倚风险（Robins-I）进行分析，随机对照试验采用偏倚风险2（RoB-2）进行分析。本评价已在国际前瞻性系统评价注册数据库中注册。使用R软件进行荟萃分析，P<0.05被认为具有统计学意义。
分析了12项比较研究中的数据，共1303例患者（1352例rTKA）。混合固定和骨水泥固定的生存率相当，有显著趋势支持混合固定（P=0.04）。感染和无菌性松动是最常见的失败原因。影像学失败率在固定方法之间无显著差异（P=0.4）。荟萃分析表明混合固定的结果更好，尽管无统计学意义（KSS功能评分P=0.15；KSS临床评分P=0.5）。由于患者特征和手术策略的差异，观察到高度异质性。
混合固定和骨水泥固定技术在rTKA中均取得了满意的临床结果，混合固定的总体失败率较低。固定方法的选择必须根据个体患者特征和手术考虑因素进行调整。需要进一步的高质量随机试验来完善这些结果，并优化固定策略以改善患者预后。
IV级。
