Hajiaghajani Sina, Bahrami Omid, Hefzosseheh Mohammadhossein, Alaei Maryam, Mehrvar Amir, Poursalehian Mohammad
Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Student Research Committee, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
J Orthop Surg Res. 2025 May 3;20(1):442. doi: 10.1186/s13018-025-05858-1.
Patellar component design in total knee arthroplasty (TKA) can influence patellofemoral kinematics and clinical outcomes. The medialized dome design (MDD) aligns the patella apex more medially, while the anatomic patella design (APD) aims to replicate the native patella's shape and tracking. Although biomechanical studies suggest potential benefits of APD, clinical evidence remains inconclusive.
A systematic review and meta-analysis following PRISMA guidelines was conducted to compare the clinical outcomes of MDD and APD in a modern posterior-stabilized TKA (ATTUNE system). We searched PubMed, Scopus, Embase, and Web of Science on January 10, 2025, without language or date restrictions. Eligible studies included randomized controlled trials (RCTs) and comparative cohort designs evaluating patient-reported outcome measures (PROMs), revisions, complications, range of motion (ROM), and radiologic measures of patellar stability. Risk of bias was assessed using RoB-2 for RCTs and ROBINS-I for cohort studies. Pooled effect sizes were calculated using Hedges's g and random-effects modeling.
Seven studies, including three RCTs and four cohort studies, with a total of 1,069 patients and 1,113 knees (507 APD vs. 606 MDD), were included. The meta-analysis demonstrated no significant difference in PROMs (Hedges's g = 0.09; 95% CI [-0.04 to 0.22]; P = 0.17) or ROM (Hedges's g = 0.02; 95% CI [-0.21 to 0.26]; P = 0.83) between APD and MDD. While revision rates and complications were higher for APD, the differences were not statistically significant compared to MDD (14 vs 9). Radiographic measures showed inconsistencies and did not definitively favor either design.
Current evidence suggests that APD offers no clear clinical advantage over MDD in the ATTUNE posterior-stabilized TKA. Both designs yield broadly comparable PROMs and knee function outcomes. Larger RCTs with extended follow-up are warranted to clarify the safety of APD.
III.
全膝关节置换术（TKA）中髌骨组件的设计会影响髌股关节运动学和临床结果。内侧化穹顶设计（MDD）使髌骨顶点更向内侧对齐，而解剖型髌骨设计（APD）旨在复制天然髌骨的形状和轨迹。尽管生物力学研究表明APD有潜在益处，但临床证据仍不明确。
按照PRISMA指南进行系统评价和荟萃分析，以比较现代后稳定型TKA（ATTUNE系统）中MDD和APD的临床结果。2025年1月10日，我们在PubMed、Scopus、Embase和Web of Science上进行检索，无语言或日期限制。符合条件的研究包括随机对照试验（RCT）和比较队列设计，评估患者报告的结局指标（PROM）、翻修、并发症、活动范围（ROM）以及髌骨稳定性的影像学指标。使用RoB-2评估RCT的偏倚风险，使用ROBINS-I评估队列研究的偏倚风险。采用Hedges's g和随机效应模型计算合并效应量。
纳入7项研究，包括3项RCT和4项队列研究，共1069例患者、1113个膝关节（507个APD vs. 606个MDD）。荟萃分析表明，APD和MDD在PROM（Hedges's g = 0.09；95%CI[-0.04至0.22]；P = 0.17）或ROM（Hedges's g = 0.02；95%CI[-0.21至0.26]；P = 0.83）方面无显著差异。虽然APD的翻修率和并发症发生率较高，但与MDD相比差异无统计学意义（14例vs. 9例）。影像学测量结果不一致，未明确支持任何一种设计。
目前的证据表明，在ATTUNE后稳定型TKA中，APD相对于MDD没有明显的临床优势。两种设计产生的PROM和膝关节功能结果大致相当。需要开展更大规模、随访时间更长的RCT来阐明APD的安全性。
III级
