Al-Sarraj Mohammed K, Hasan Laith K, Woodhams William H, Srivastava Ajay K, Atkinson Patrick J, Atkinson Theresa S
Orthopaedic Surgery, McLaren-Flint, Flint, Michigan.
College of Human Medicine, Michigan State University, East Lansing, Michigan.
J Arthroplasty. 2025 Jun 7. doi: 10.1016/j.arth.2025.06.006.
Total knee arthroplasty (TKA) successfully treats end-stage knee osteoarthritis; however, aseptic loosening and subsequent revision remain concerns. Use of tibial stem extensions may enhance component fixation and reduce loosening. This study evaluated whether short tibial extensions reduce revision due to aseptic loosening in primary TKA for: (1) all patients identified in the systematic review; and (2) patients in specific subgroups.
A systematic review and meta-analysis were conducted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and Embase databases were searched for studies published between 2010 and 2023, focusing on primary cemented TKA with short (30 mm) tibial stem extensions. A total of 23,235 patients were included for analysis, who had a mean age of 66.3 years for tibial stem extension (test) groups and 66.6 years for standard tibial stems (controls). The quality of included studies was assessed using the Newcastle-Ottawa Scale, and a random-effects model was used to perform the meta-analysis.
Meta-analysis showed that a short tibial extension was associated with a significant reduction in revisions due to aseptic loosening for all patients (odds ratio 0.34, P = 0.0001). Subgroup analysis showed that significantly fewer revisions (α = 0.025 following multiple comparison adjustment) were associated with a tibial extension for overweight/obese patients (P = 0.011), but not for those who had a preoperative varus (> 8°) (P = 0.027).
This systematic review and meta-analysis indicate that short tibial extensions are associated with a significant reduction in the likelihood of revision due to aseptic loosening after primary TKA. A reduced incidence of revisions was observed specifically in overweight/obese patients. Short tibial extensions may enhance fixation in select patients. While additional high-quality studies are still needed, these findings suggest orthopaedic surgeons should consider short tibial extensions for certain TKA patients.
全膝关节置换术（TKA）成功治疗终末期膝关节骨关节炎；然而，无菌性松动及后续翻修仍是令人担忧的问题。使用胫骨柄延长装置可能会增强假体固定并减少松动。本研究评估了短胫骨延长装置是否能减少初次TKA中因无菌性松动导致的翻修，针对：（1）系统评价中纳入的所有患者；（2）特定亚组患者。
按照系统评价和Meta分析的首选报告项目指南进行系统评价和Meta分析。检索PubMed和Embase数据库中2010年至2023年发表的研究，重点关注采用短（30 mm）胫骨柄延长装置的初次骨水泥型TKA。共纳入23235例患者进行分析，胫骨柄延长装置（试验）组的平均年龄为66.3岁，标准胫骨柄（对照组）的平均年龄为66.6岁。使用纽卡斯尔-渥太华量表评估纳入研究的质量，并采用随机效应模型进行Meta分析。
Meta分析表明，对于所有患者，短胫骨延长装置与因无菌性松动导致的翻修显著减少相关（比值比0.34，P = 0.0001）。亚组分析显示，超重/肥胖患者使用胫骨延长装置后翻修显著减少（多重比较调整后α = 0.025）（P = 0.011），但术前存在内翻（> 8°）的患者则不然（P = 0.027）。
本系统评价和Meta分析表明，短胫骨延长装置与初次TKA后因无菌性松动导致的翻修可能性显著降低相关。尤其在超重/肥胖患者中观察到翻修发生率降低。短胫骨延长装置可能会增强特定患者的固定效果。虽然仍需要更多高质量研究，但这些发现表明骨科医生应为某些TKA患者考虑使用短胫骨延长装置。
