Khani Yashar, Mehrvar Amir, Mohebbi Sadra, Hefzosseheh Mohammadhossein, Aliakbari Mahya, Mansouri Rad Fateme, Poursalehian Mohammad
Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Clinical Research Development Units, Taleghani Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran.
JB JS Open Access. 2025 Aug 7;10(3). doi: 10.2106/JBJS.OA.25.00136. eCollection 2025 Jul-Sep.
The Forgotten Joint Score (FJS) is a patient-reported outcome measure developed to assess joint awareness, potentially differentiating between "good" and "excellent" outcomes. Prosthetic designs, specifically cruciate-retaining (CR) and cruciate-substituting (cruciate sacrificing/substituting [CS]) implants, may influence joint awareness due to differences in posterior cruciate ligament (PCL) preservation. Our objective was to compare the joint awareness outcomes, measured by the FJS, between CR and CS implants in total knee arthroplasty (TKA).
A systematic review and meta-analysis were conducted following PRISMA guidelines. Scopus, PubMed, Embase, and Web of Science were searched up to March 2024 without date or language restrictions. Studies comparing CR and CS implants reporting FJS outcomes were included. Data extracted included study characteristics, patient demographics, intervention details, follow-up durations, and FJS scores. Risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Intervention-I tool. A random-effects meta-analysis using Hedges g was performed, with sensitivity analyses and meta-regression to explore heterogeneity.
Seventeen cohort studies involving 4,245 patients were included. The meta-analysis demonstrated that CS implants were superior to CR implants in terms of FJS (Hedges g = -0.39; p = 0.018), indicating a small to medium effect size favoring CS designs. High heterogeneity was observed (I = 95.69%). Sensitivity analyses yielded similar results, and meta-regression did not identify significant sources of heterogeneity.
CS implants are associated with superior joint awareness compared with CR implants in TKA, as measured by the FJS. Despite the theoretical advantage of PCL preservation, CR implants did not demonstrate better joint awareness. The findings should be interpreted with caution due to study heterogeneity and limitations in study design. Further high-quality randomized controlled trials are necessary to confirm these results.
遗忘关节评分（FJS）是一种患者报告的结局指标，旨在评估关节感知，可能区分“良好”和“优秀”的结局。假体设计，特别是保留交叉韧带（CR）和替代交叉韧带（牺牲/替代交叉韧带[CS]）的植入物，可能因后交叉韧带（PCL）保留情况的差异而影响关节感知。我们的目的是比较全膝关节置换术（TKA）中CR和CS植入物在FJS测量下的关节感知结局。
按照PRISMA指南进行系统评价和荟萃分析。截至2024年3月，对Scopus、PubMed、Embase和Web of Science进行了检索，无日期或语言限制。纳入比较报告FJS结局的CR和CS植入物的研究。提取的数据包括研究特征、患者人口统计学、干预细节、随访时间和FJS评分。使用干预非随机研究中的偏倚风险-I工具评估偏倚风险。使用Hedges g进行随机效应荟萃分析，并进行敏感性分析和荟萃回归以探讨异质性。
纳入了17项队列研究，涉及4245名患者。荟萃分析表明，在FJS方面，CS植入物优于CR植入物（Hedges g = -0.39；p = 0.018），表明有利于CS设计的效应大小为小到中等。观察到高度异质性（I = 95.69%）。敏感性分析得出了相似的结果，荟萃回归未发现异质性的重要来源。
在TKA中，通过FJS测量，CS植入物与比CR植入物更好的关节感知相关。尽管PCL保留具有理论优势，但CR植入物并未表现出更好的关节感知。由于研究异质性和研究设计的局限性，这些发现应谨慎解释。需要进一步的高质量随机对照试验来证实这些结果。
