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Yao K, Chen Y. Comprehensive evaluation of risk factors for aseptic loosening in cemented total knee arthroplasty: A systematic review and meta-analysis. J Exp Orthop 2024; 11:e12095. [PMID: 39035847 PMCID: PMC11260281 DOI: 10.1002/jeo2.12095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/03/2024] [Indexed: 07/23/2024] Open
Abstract
Purpose Aseptic loosening is the most common cause for revisions after total knee arthroplasty (TKA). Despite many studies exploring various risk factors associated with aseptic loosening, findings often present inconsistencies. To address this, we conducted a thorough review of the literature to identify and analyse these risk factors in cemented TKA. Additionally, we performed a meta-analysis to reconcile the divergent conclusions observed across studies. Methods We searched PubMed, Web of Science and Embase from 1996 up to 2024 and evaluated the quality of the included literature. Seventy-four studies were included to assess the association of BMI, diabetes, high physical activity (HPA), osteoporosis, rheumatoid arthritis (RA), cement material and implant design. Twenty-nine studies were used to calculate relative risk and CIs (using the random effects theory) and study heterogeneity for six different risk factors (BMI, diabetes, HPA level, cement material, polyethylene and implant design). Results Patients with diabetes are eight times more likely to experience aseptic loosening compared to those without diabetes (RR = 9.18, 95% CI: 1.80-46.77, p < 0.01). The use of tibial stem extension or highly crosslinked polyethylene can help reduce the incidence of aseptic loosening. However, we did not identify BMI, HPA, osteoporosis, RA, the use of high-viscosity cement and the utilization of mobile-bearing designs as risk factors for aseptic loosening post-cemented TKA. Conclusions Patients with diabetes undergoing TKA should be counselled regarding their potential increased risk of aseptic loosening. The use of tibial stem extensions and HXLPE can mitigate the incidence of aseptic loosening in cemented TKA. However, given a limited number of studies were included in the meta-analysis, we believe that higher-level studies are necessary to clearly identify other risk factors. Level of Evidence Level III.
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Affiliation(s)
- Kaiyi Yao
- Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
| | - Yao Chen
- Department of Applied Mathematics, Computer Science and StatisticsGhent UniversityGhentBelgium
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and NutritionGhent UniversityMerelbekeBelgium
- DIGPCR‐Ghent University Digital PCR ConsortiumGhent UniversityMerelbekeBelgium
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Nazarieh M, Ghannadi S, Halabchi F, Maleklou F, Ejtehadi F, Ehsani Kouhikheili SR, Kluzek S, Alizadeh Z. The effect of intra-articular ozone injection combined with home-based exercise on pain and function in daily living activities of patients with mild to moderate knee osteoarthritis, a randomized double-blinded controlled clinical trial. J Bodyw Mov Ther 2024; 38:541-548. [PMID: 38763606 DOI: 10.1016/j.jbmt.2024.03.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 02/24/2024] [Accepted: 03/22/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Knee osteoarthritis is the most common arthritis. Various treatments such as analgesics, exercise therapy, and surgery in high-grade OA have been shown to reduce pain and improve patients' function; however, determining the optimal treatment remains a challenge. Ozone therapy is one of the injection techniques used for symptom relief in these patients. Therefore, this study aimed to evaluate the effect of ozone injection in mild to moderate knee osteoarthritis. METHODS Thirty-three patients with grade II-III knee osteoarthritis based on the Kellgren-Lawrence classification were involved in the study, by block randomisation. Totally 42 knees were included. All patients received exercise therapy, 500 mg of acetaminophen tablets (up to 2 g per day as needed), and healthy nutrition. In a double-blinded method, the intervention group received Ozone injections, but the control group received placebo injections. Functional tests, including timed-up-and-go and 6-min walk tests, were assessed at baseline and immediately after the 6-week intervention. In addition, the pain was measured by VAS score, and stiffness and activity of daily living (ADL) were evaluated by KOOS questionnaire before and after a 6-week intervention and then one and six months afterwards. FINDINGS Improvements in pain and KOOS scores were seen in both groups in the 6th week of injections (p < 0.05), with significant differences between groups. However, the effects on pain and KOOS scores disappeared in the 1st and 6th months of follow-ups in the control group. Nevertheless, the effects persisted in the intervention group compared to the baseline and control group, which means that in the mentioned time points intervention group showed significant improvement compared to the control group (p < 0.05). In addition, functional tests showed significant differences between the two groups in the 6th week of injections (p < 0.001). INTERPRETATION Ozone injection is a non-surgical treatment for mild to moderate knee osteoarthritis that could decrease pain and improve function and ADL of patients in the short to mid-term (3-6 months), so it seems that adding Ozone injection to the routine exercise therapy in management of patients with knee OA could improve outcomes.
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Affiliation(s)
- Mahshid Nazarieh
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Shima Ghannadi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Farzin Halabchi
- Department of Sports and Exercise Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Faezeh Maleklou
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Fatemeh Ejtehadi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Stefan Kluzek
- Queen's Medical Centre, University of Nottingham, Nottingham, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK.
| | - Zahra Alizadeh
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Sports and Exercise Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
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Beiene ZA, Tanghe KK, Neitzke CC, Hidaka C, Lyman S, Gausden EB, McLawhorn AS. Patient Selection in Randomized Controlled Trials of Total Knee Arthroplasty: A Systematic Review Assessing Inclusion Criteria. J Bone Joint Surg Am 2024; 106:553-563. [PMID: 38252710 DOI: 10.2106/jbjs.23.00629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Patients undergo total knee arthroplasty (TKA) at widely disparate stages of osteoarthritis, raising the possibility of high heterogeneity among patients enrolled in TKA research studies. Obscuration of treatment effectiveness and other problems that may stem from cohort heterogeneity can be controlled in clinical studies by rigorously defining target patients. The purpose of this review was to determine the extent to which randomized controlled trials (RCTs) on TKA use osteoarthritis severity, as defined by radiographic grade or patient-reported outcome measures (PROMs), in their inclusion criteria, and to investigate potential impact on outcome. METHODS A search of PubMed, Embase, Scopus, Web of Science, and Cochrane databases used a combination of terms involving TKA, PROMs, and radiographic scoring. A total of 1,227 studies were independently reviewed by 2 screeners for the above terms. RCTs with ≥100 patients (236) and with <100 patients (325) undergoing TKA were analyzed with regard to the specific inclusion criteria and recruitment process. RESULTS Among the identified RCTs with ≥100 patients, 18 (<8%, with a total of 2,952 randomized patients) used specific radiographic scoring or PROM thresholds in their inclusion criteria. Eleven of the 18 studies used specific radiographic scoring, such as the Kellgren-Lawrence or Ahlbäck classifications. Three studies used preoperative PROM thresholds: Knee Society Knee Score of <60, Knee Society Function Score of <60, Oxford Knee Score of <20, and Hospital for Special Surgery Score of <60. Among studies with <100 patients, 48 (<15%) used specific inclusion criteria. CONCLUSIONS The vast majority of RCTs (>85%) did not enroll patients based on disease severity, as measured by PROM score thresholds or radiographic classifications, in their inclusion criteria. The lack of consistent inclusion criteria likely results in heterogeneous cohorts, potentially undermining the validity of RCTs on TKA. LEVEL OF EVIDENCE Prognostic Level I . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Zodina A Beiene
- Department of Anesthesiology and Critical Care, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Colin C Neitzke
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Chisa Hidaka
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Stephen Lyman
- Healthcare Research Institute, Hospital for Special Surgery, New York, NY
| | - Elizabeth B Gausden
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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Elmhiregh A, Abuodeh Y, Alzobi O, Zikria B, Alkhayarin M, Morrey BF. All-polyethylene versus metal-backed tibial components in total knee arthroplasty: a meta-analysis of randomized controlled trials. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3611-3622. [PMID: 37249643 PMCID: PMC10651551 DOI: 10.1007/s00590-023-03594-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 05/14/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The design of tibial trays for total knee arthroplasty (TKA) has been a topic of research for several decades. Although all-polyethylene trays were developed to address issues such as osteolysis and to enhance the longevity of the prosthesis, as well as knee range of motion, metal-backed designs have remained the most commonly used type of prosthesis. This meta-analysis aimed to compare the clinical, radiological, and survival outcomes of both designs. METHODS Five databases were searched from inception until October 1, 2020, for randomized controlled trials (RCTs) that compared the outcomes of all-polyethylene and metal-backed tibial components in TKA. The outcomes of interest included range of motion, knee society score, stairs climbing scores, radiostereographic analysis, survivorship and complication. This review was conducted in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias was assessed using the Newcastle-Ottawa tool. RESULTS A total of 14 RCTs with 1367 TKA were included with a mean age of - years and - years for all-polyethylene and metal-backed tibial components groups, respectively. All-polyethylene group demonstrated statistically significant differences in five-year survivorship (OR 0.27; 95% CI 0.10-0.75; p value 0.01) and stairs climbing score (OR - 2.07; 95% CI - 3.27-0.87; p value 0.0007) when compared to the metal-backed group. The metal-backed design was significantly more radiographically stable in anterior-posterior, varus-valgus, and internal-external rotations at the 2-year follow-up compared to all-polyethylene tibias (OR - 0.09; 95% CI - 0.16 to - 0.02; p value 0.02) as per the pooled radiostereographic analysis. However, ten-year survivorship (OR 0.92; 95% CI 0.53-1.60; p value 0.78), range of motion (OR - 0.57; 95% CI - 2.00-0.85, p value 0.43), knee society scores (OR 1.38; 95% CI - 0.47-3.23, p value 0.14), and complications (OR 0.83; 95% CI 0.5-1.39, p value 0.48) were comparable between both groups. CONCLUSIONS While this meta-analysis suggests that all-polyethylene tibial components in total knee arthroplasty may offer advantages over metal-backed components in terms of five-year survivorship, and stairs climbing score, this finding should be considered in the context of potential confounding factors. Nonetheless, based on the results, the all-polyethylene implant should be considered a viable choice for primary knee replacement. LEVEL OF EVIDENCE I.
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Affiliation(s)
| | - Yousef Abuodeh
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Osama Alzobi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
| | - Bashir Zikria
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Mohd Alkhayarin
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
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Kalaai S, Most J, van Dun B, Kaptein BL, Tilman PBJ, Boonen B, Schotanus MGM. Less wear in deep-dished mobile compared to fixed bearing total knee arthroplasty of the same design at 5-year follow-up: a randomised controlled model-based Roentgen stereophotogrammetric analysis trial. Knee Surg Sports Traumatol Arthrosc 2023; 31:5137-5144. [PMID: 37796308 DOI: 10.1007/s00167-023-07584-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/08/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE The aim of this prospective randomised controlled study was to compare wear characteristics and functional outcome between deep-dished mobile bearing (MB) and fixed bearing (FB) cemented total knee arthroplasty (TKA). We hypothesised that deep-dished MB reduces polyethylene wear and improves patient-reported outcome measures. METHODS A total of 50 patients were randomised to receive a MB or FB tibia component of the same cemented TKA design. Patients were evaluated over a 5-year follow-up period. Medial and lateral wear were assessed using model-based Roentgen Stereophotogrammetric Analysis (RSA) and compared with the direct postoperative minimal joint space measurement. Functional outcome was assessed by the clinician-derived KSS and OKS, WOMAC, LEAS, and FJS-12. All data were derived using a general linear mixed model. RESULTS At 5-year follow-up, decreased wear in the MB compared to the FB group was observed on the lateral side (0.07 ± 0.17 mm, p = 0.026), but not on the medial side (0.31 ± 0.055 mm, p = 0.665). Functional outcomes improved with a statistical significant effect over time, with no significant differences between groups (all p > 0.17). CONCLUSION This model-based RSA study with 5-year follow-up showed that cemented deep-dished MB reduced lateral polyethylene wear as compared to FB in a single TKA system, whilst clinical outcomes were comparable. Longer follow-up is needed to establish clinical implications of these altered wear patterns and determine type of wear. LEVEL OF EVIDENCE Level 1 randomised controlled trial.
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Affiliation(s)
- S Kalaai
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands.
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
| | - J Most
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - B van Dun
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- Department of Orthopaedic Surgery and Traumatology, Imelda Hospital, Bonheiden, Belgium
| | - B L Kaptein
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - P B J Tilman
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - B Boonen
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - M G M Schotanus
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, The Netherlands
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Tsai YL, Tsai SHL, Lin CH, Lin CR, Hu CC. The Effect of Congruent Tibial Inserts in Total Knee Arthroplasty: A Network Meta-Analysis of Randomized Controlled Trials. Life (Basel) 2023; 13:1942. [PMID: 37763345 PMCID: PMC10532924 DOI: 10.3390/life13091942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Objective: The aim of this study was to determine whether modern congruent tibial inserts are associated with superior outcomes in total knee arthroplasty (TKA). Background: Ultracongruent fixed-bearing (UCFB) and medial congruent fixed-bearing (MCFB) inserts have been known to be effective in total knee arthroplasty with patient satisfaction. Nonetheless, no supporting evidence to date exists to rank the clinical outcomes of these various congruent inserts in TKA compared with other important considerations in TKA including cruciate-retaining fixed-bearing (CRFB) and posterior-stabilized fixed-bearing (PSFB) inserts. Methods: We searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and Scopus up to 15 May 2022. We selected studies involving an active comparison of UCFB or MCFB in TKAs. We performed a network meta-analysis (NMA) of randomized controlled trials (RCTs) and compared different congruent inserts. We ranked the clinical outcomes by SUCRA score with the estimate of the best treatment probability. Our primary outcomes were revision rates and radiolucent lines. Secondary outcomes were functional scores, including the range of motion (ROM), the Knee Society Score (KSS), the Oxford Knee Score (OKS), and WOMAC. Results: Eighteen RCTs with 1793 participants were analyzed. Our NMA ranked MCFB, CRFB, and UCFB with the lowest revision rates. CRFB and UCFB had the fewest radiolucent lines. UCFB had overall the best ROM. UCFB and MCFB had the best OKS score overall. Conclusions: The ranking probability for better clinical outcomes in congruent inserts demonstrated the superiority of congruent tibial inserts, including UCFB and MCFB. UCFB may be associated with better ROM and postoperative functional outcomes. However, integrating future RCTs for high-level evidence is necessary to confirm these findings.
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Affiliation(s)
- Yen-Lin Tsai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fu-Hsin St. Kweishan County, Taoyuan 333, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fu-Hsin St. Kweishan County, Taoyuan 333, Taiwan
| | - Sung Huang Laurent Tsai
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fu-Hsin St. Kweishan County, Taoyuan 333, Taiwan
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan
| | - Chia-Han Lin
- Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan
| | - Chun-Ru Lin
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fu-Hsin St. Kweishan County, Taoyuan 333, Taiwan
| | - Chih-Chien Hu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fu-Hsin St. Kweishan County, Taoyuan 333, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fu-Hsin St. Kweishan County, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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Hegde V, Kendall J, Schabel K, Pelt CE, Yep P, Mullen K, De A, Kagan R. The James A. Rand Young Investigator's Award: Increased Revision Risk With Mobile Bearings in Total Knee Arthroplasty: An Analysis of the American Joint Replacement Registry. J Arthroplasty 2023:S0883-5403(23)00007-4. [PMID: 36639116 DOI: 10.1016/j.arth.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/25/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Mobile-bearing (MB) total knee arthroplasty (TKA) may reduce wear and improve patellar tracking but may increase revision risk due to tibial component design, balance complexity, and bearing dislocation. We utilized the American Joint Replacement Registry to examine risk of revision with MB compared to fixed-bearing (FB) designs. METHODS An analysis of primary TKA in patients over 65 years was performed with American Joint Replacement Registry data linked to Centers for Medicare and Medicaid Services data from 2012 to 2019. Analyses compared MB to FB designs with a subanalysis of implants from a single company. We identified 485,024 TKAs, with 452,199 (93.2%) FB-TKAs and 32,825 (6.8%) MB-TKAs. Cox proportional hazards regression modeling was used for all-cause revision and revision for infection, adjusting for sex, age, and competing risk of mortality. Event-free survival curves evaluated time to all-cause revision and revision for infection. RESULTS MB-TKAs were at an increased risk for all-cause revision: hazard ratio (HR) 1.36 ([95% confidence interval (CI) 1.24-1.49], P < .0001) but not revision for infection: HR 1.06 ([95% CI 0.90-1.25], P = .52). When comparing implants within a single company, MB-TKAs were at an increased risk of all-cause revision: HR 1.55 ([95% CI 1.38-1.73], P < .0001). Event-free survival curves demonstrated increased risk for all-cause revision for MB-TKA across all time points, with a greater magnitude of risk up to 8 years. CONCLUSION Although survivorship of both designs was outstanding, MB-TKA designs demonstrated increased risk for all-cause revision. Additional investigation is needed to determine if this is related to patient selection factors, surgical technique, bearing, or implant design.
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Affiliation(s)
- Vishal Hegde
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Jamil Kendall
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Kathryn Schabel
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Christopher E Pelt
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Patrick Yep
- American Academy of Orthopaedic Surgeons, Registries and Data Science Department, Rosemont, Illinois
| | - Kyle Mullen
- American Academy of Orthopaedic Surgeons, Registries and Data Science Department, Rosemont, Illinois
| | - Ayushmita De
- American Academy of Orthopaedic Surgeons, Registries and Data Science Department, Rosemont, Illinois
| | - Ryland Kagan
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
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Sohn S, Koh IJ, Kim MS, Choi KY, Lim DS, In Y. Mobile-Bearing has no Benefit Over Fixed-Bearing Total Knee Arthroplasty in Joint Awareness and Crepitus: A Randomized Controlled Trial. J Arthroplasty 2023; 38:78-84. [PMID: 35934188 DOI: 10.1016/j.arth.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Given higher component conformity, rotational availability of polyethylene insert, and more physiologic patellofemoral tracking, mobile-bearing (MB) total knee arthroplasty (TKA) is supposed to offer advantages in joint perception and crepitus. The purpose of this study was to investigate whether MB TKA offers superior outcomes over fixed-bearing (FB) TKA in terms of joint awareness and crepitus. METHODS This prospective, randomized, controlled trial included 49 FB and 49 MB TKAs that shared the same posterior-stabilized femoral component. Primary outcomes included joint awareness assessed with the Forgotten Joint Score and crepitus graded according to severity and sound at 3 years postoperatively. Secondary outcomes were the range of motion, the Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, component position, and joint line level on radiographs. RESULTS The Forgotten Joint Score showed no significant difference between the FB (67 points; range, 0-100) and MB groups (63 points; range, 13-100) (P = .440). For crepitus, no significant differences were found in the overall incidence rate (FB group, 18%; MB group, 12%; P = .386) and grade (grade 1, 6 versus 5; grade 2, 2 versus 1; grade 3, 1 versus 0, respectively). There were no significant differences in range of motion, Knee Society Score, and Western Ontario and McMaster Universities Osteoarthritis Index, as well as radiographic outcomes between the two groups (all, P > .05). CONCLUSION MB TKA offers no benefits in terms of joint awareness and crepitus compared with FB TKA at mean 3 years postoperatively. The theoretical advantages of MB TKA have yet to be demonstrated in practice, leaving the selection of bearing type to the surgeon's judgment. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Sueen Sohn
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Keun Young Choi
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Da Sol Lim
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Ruckenstuhl P, Revelant F, Hauer G, Bernhardt GA, Leitner L, Gruber G, Leithner A, Sadoghi P. No difference in clinical outcome, pain, and range of motion between fixed and mobile bearing Attune total knee arthroplasty: a prospective single-center trial. BMC Musculoskelet Disord 2022; 23:413. [PMID: 35501786 PMCID: PMC9063062 DOI: 10.1186/s12891-022-05382-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/25/2022] [Indexed: 12/11/2022] Open
Abstract
Background Despite numerous scientific investigations, the tribological advantages of mobile bearing inserts have not been sustainably confirmed or refuted for modern knee prostheses in clinical studies. The purpose of this study was to compare fixed and mobile bearing inserts in order to draw conclusions regarding clinical benefits. Methods The present prospective single center cohort study of 2 non-randomized stratified groups consisted of 67 patients. All included patients received cemented total knee arthroplasty (Attune®) due to osteoarthritis. 34 patients were treated with a mobile and 33 patients with a fixed insert. The WOMAC score and the Visual Analogue Scale was used for the subjective assessment of success, while the Knee-Society-Score was used considering the Range of Motion for the objective assessment. The subjective and the clinical scores showed improvements for both compared groups postoperatively at 2 years of minimum follow-up. Results The overall postoperative results of the WOMAC score, the Knee-Society-Score and the Visual Analogue Scale presented no statistically difference between the compared groups (p > 0,05). The postoperative ROM showed a superior improvement of 13.2° ± 18.4° in the mobile-bearing group versus 4.9° ± 18.4° (p = 0.017) in the fixed-bearing group. The flexion of the knee joint was 114° ± 10.1° for the mobile-bearings and 109.2° ± 7.2° for fixed bearings (p = 0.012). Conclusion According to the findings, both inserts showed overall promising postoperative results, in terms of objective as well as subjective parameters, without clinically relevant significant differences, except for ROM, which was superior in the mobile bearing group. The present clinical trial has been registered at the ISRCTN registry with the reverence number ISRCTN15117998 on 04/04/2022. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05382-x.
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Affiliation(s)
- Paul Ruckenstuhl
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Fabio Revelant
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Georg Hauer
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Gerwin A Bernhardt
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Lukas Leitner
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Gerald Gruber
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria.
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Shatrov J, Sappey-Marinier E, Kafelov M, Gunst S, Batailler C, Servien E, Lustig S. Similar outcomes including maximum knee flexion between mobile bearing condylar-stabilised and fixed bearing posterior-stabilised prosthesis: a case control study. J Exp Orthop 2022; 9:17. [PMID: 35169966 PMCID: PMC8847635 DOI: 10.1186/s40634-022-00456-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/11/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose Prosthesis design influences stability in total knee arthroplasty and may affect maximum knee flexion. Posterior-stabilised (PS) and condylar-stabilised (CS) designed prosthesis do not require a posterior-cruciate ligament to provide stability. The aim of the current study was to compare the range of motion (ROM) and clinical outcomes of patients undergoing cemented total knee arthroplasty (TKA) using either a PS or CS design prosthesis. Methods A total of 167 consecutive primary TKAs with a CS bearing (mobile deep-dish polyethylene) were retrospectively identified and compared to 332 primary TKA with a PS constraint, with similar design components from the same manufacturer. Passive ROM was assessed at last follow-up with use of a handheld goniometer. Clinical scores were assessed using Patient-Reported Outcome Measures (PROMs); International Knee Society (IKS) knee and function scores and satisfaction score. Radiographic assessment was performed pre and post operatively consisting of mechanical femorotibial angle (mFTA), femoral and tibial mechanical angles measured medially (FMA and TMA, respectively) on long leg radiographs, tibial slope and patella height as measured by the Blackburne-Peel index (BPI). Results Both groups had a mean follow-up of 3 years (range 2–3.7 years). Mean post-operative maximum knee flexion was 117° ± 4.9° in the PS group and 119° ± 5.2° in the CS group (p = 0.29). Postoperative IKS scores were significantly improved in both groups compared to preoperative scores (p < 0.01). The mean IKS score in the PS group was 170.9 ± 24.1 compared to 170.3 ± 22.5 in the CS group (p = 0.3). Both groups had similar radiographic outcomes as determined by coronal and sagittal alignment, tibial slope and posterior condylar offset ratio measurements. When considering the size of tibial slope change and posterior-condylar offset ratio, there was no differences between groups (p = 0.4 and 0.59 respectively). The PS group had more interventions for post-operative stiffness (arthrolysis or manipulation under anaesthesia) 8 (2.7%) compared to 1 (0.6%) in the CS group (p = 0.17). Conclusion Condylar-stabilised TKA have similar patient outcomes and ROM at a mean follow-up of 3 years compared to PS TKA. Highly congruent inserts could be used without compromising results in TKA at short term. Level of evidence Level IV, retrospective case control study.
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Affiliation(s)
- Jobe Shatrov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.,Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia.,University of Notre Dame Australia, Sydney, Australia.,Hornsby and Ku-Ring Hospital, Sydney, Australia
| | - Elliot Sappey-Marinier
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France. .,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France.
| | - Moussa Kafelov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Stanislas Gunst
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.,LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
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11
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Sappey-Marinier E, Swan J, Maucort-Boulch D, Batailler C, Malatray M, Neyret P, Lustig S, Servien E. No significant clinical and radiological differences between fixed versus mobile bearing total knee replacement using the same semi-constrained implant type: a randomized controlled trial with mean 10 years follow-up. Knee Surg Sports Traumatol Arthrosc 2022; 30:603-611. [PMID: 33151364 DOI: 10.1007/s00167-020-06346-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/21/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to compare the long-term clinical and radiological results between fixed (FB) and mobile bearing (MB) implants with identical design from the same manufacturer. METHODS From March 2007 to May 2009, we recruited 160 patients in a prospective, single centered, randomized controlled trial. The authors compared 81 FB total knee arthroplasty (TKA) versus 79 MB with medial compartment osteoarthritis. The same posterior stabilized HLS Noetos knee prosthesis (CORIN) was used in all patients. The two groups only differed by the tibial insert (fixed or mobile). The authors compared the postoperative Knee Society Score (KSS), the passive clinical and active radiological knee flexion, the implant survivorship, the complications, and the presence of radiolucent lines. RESULTS At mean 10.5 years' follow-up (range 8-12.1 years) no significant differences were found in clinical scores (KSS (p = 0.54), pain score (p = 0.77), stair climbing (p = 0.44), passive maximum flexion (p = 0.5)) or for radiological analyses (maximum active radiological flexion (p = 0.06), presence of progressive radiolucent lines (5 (MB group) versus 6 (FB group); p = 0.75)) between groups. No significant difference was found in overall implant survivorship (82% (MB group) versus 78% (FB group) p = 0.58) or complication rate (p = 0.32) at the last follow-up. CONCLUSION No significant clinical and radiological differences were found between fixed and mobile bearing TKA using the same semi-constrained implant type with comparable overall survivorship. The choice between a fixed or mobile bearing implant should be based on surgeon preference and experience with the selected implant. LEVEL OF EVIDENCE Prospective randomized controlled trial, Level II.
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Affiliation(s)
- E Sappey-Marinier
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, 69004, Lyon, France.
| | - J Swan
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, 69004, Lyon, France
| | - D Maucort-Boulch
- Service de Biostatistique - Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69003, Lyon, France
- Université de Lyon, 69000, Lyon, France
- Université Lyon 1, 69100, Villeurbanne, France
- CNRS, UMR5558, Laboratoire de Biométrie Et Biologie Évolutive, Équipe Biostatistique-Santé, 69100, Villeurbanne, France
| | - C Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, 69004, Lyon, France
| | - M Malatray
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, 69004, Lyon, France
| | - P Neyret
- Infirmerie Protestante Lyon Caluire, 3 chemin du Penthod, 69300, Caluire et cuire, France
| | - S Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, 69004, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - E Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, 69004, Lyon, France
- LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
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12
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Chen P, Huang L, Zhang D, Zhang X, Ma Y, Wang Q. Mobile Bearing versus Fixed Bearing for Total Knee Arthroplasty: Meta-analysis of Randomized Controlled Trials at Minimum 10-Year Follow-up. J Knee Surg 2022; 35:135-144. [PMID: 32590865 DOI: 10.1055/s-0040-1713356] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This meta-analysis aimed to compare the clinical and radiographic outcomes between mobile-bearing total knee arthroplasty (MB-TKA) and fixed-bearing total knee arthroplasty (FB-TKA) at a minimum 10-year follow-up. PubMed, EMBASE, and Cochrane databases were searched. All included articles were evaluated by two trained reviewers according to the guidelines of the Cochrane Collaboration Handbook for potential risk, and the Consolidated Standards on Reporting Trials (CONSORT) checklist and scoring system was also used to assess the methodological quality of each study. The extracted data included function scores, range of motion (ROM) of the knee, incidence of adverse events or revision, survivorship analysis, and radiographic outcomes. Seven randomized controlled trials (RCTs) were included in this meta-analysis, and all RCTs had a follow-up period longer than 10 years. This meta-analysis shows no significant difference between the two groups with respect to the Keen Society Score (KSS; p = 0.38), KSS function score (p = 0.30), the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC; p = 0.59), ROM (p = 0.71), radiolucent line (p = 0.45), femoral and tibial component positions in the coronal plane (p = 0.55 and 0.35, respectively), revision incidence (p = 0.77), and survivorship rates (p = 0.39). Meanwhile, it showed a slight difference between the two groups in the tibial component position in the sagittal plane (p = 0.003). According to this meta-analysis, the current best available evidence suggests no significant difference between the MB-TKA and FB-TKA groups with respect to the clinical outcomes, radiographic outcomes, revision, and survivorship at a minimum 10-year follow-up. This is a Level II, meta-analysis study.
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Affiliation(s)
- Pu Chen
- Department of Orthopaedic Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, People's Republic of China
| | - Liuwei Huang
- Department of Nephrology, NanFang Hospital, Sourthern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Dong Zhang
- Department of Orthopaedic Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, People's Republic of China
| | - Xiaozhe Zhang
- Department of Orthopaedic Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, People's Republic of China
| | - Yufeng Ma
- Department of Orthopaedic Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, People's Republic of China
| | - Qingfu Wang
- Department of Orthopaedic Surgery, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, People's Republic of China
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13
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No difference between mobile and fixed bearing in primary total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:3138-3154. [PMID: 35861866 PMCID: PMC9418337 DOI: 10.1007/s00167-022-07065-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/01/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Both mobile (MB) and fixed (FB) bearing implants are routinely used for total knee arthroplasty (TKA). This meta-analysis compared MB versus FB for TKA in terms of implant positioning, joint function, patient reported outcome measures (PROMs), and complications. It was hypothesised that MB performs better than FB implants in primary TKA. METHODS This meta-analysis was conducted according to the 2020 PRISMA statement. In February 2022, the following databases were accessed: Pubmed, Web of Science, Google Scholar, Embase. All the randomized clinical trials (RCTs) comparing mobile versus fixed bearing for primary TKA were considered. RESULTS Data from 74 RCTs (11,116 procedures) were retrieved. The mean follow-up was 58.8 (7.5 to 315.6) months. The MB group demonstrated greater range of motion (ROM) (P = 0.02), Knee Society Score (KSS) score (P < 0.0001), and rate of deep infections (P = 0.02). No difference was found in implant positioning: tibial slope, delta angle, alpha femoral component angle, gamma femoral component angle, beta tibial component angle, tibiofemoral alignment angle, posterior condylar offset, radiolucent lines. No difference was found in duration of the surgical procedure. No difference was found in the following PROMs: Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), function and pain subscales of the KSS score. No difference was found in the rate of anterior knee pain, revision, aseptic loosening, fractures, and deep vein thrombosis. CONCLUSION There is no evidence in support that MB implants promote greater outcomes compared to FB implants in primary TKA. LEVEL OF EVIDENCE Level I.
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Wang K, Zhang FF, Yan X, Shen Y, Cai W, Xu J, Mei J. Superior Mid- to Long-Term Clinical Outcomes of Mobile-Bearing Total Knee Arthroplasty Compared to Fixed-Bearing: A Meta-Analysis Based on a Minimum of 5 Years of Study. J Knee Surg 2021; 34:1368-1378. [PMID: 32503063 DOI: 10.1055/s-0040-1709490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As more patients undergo total knee arthroplasty (TKA) each year, and the average age of patients gets younger, the patients are generally more active requiring a greater physiological demand and increasing range of motion on the prosthesis than the previous patients. However, there is no consensus on the optimal TKA tibial bearing design. We performed this systematic review to compare the clinical differences between mobile and fixed bearing constructs used in contemporary TKA. We searched PubMed, EMBASE, and Cochrane Library databases, identifying 515 total publications, including 17 randomized controlled trials (RCTs). A meta-analysis was performed, while the quality and bias of the evidence were rated according to the Grading of Recommendations Assessment Development and Evaluation (GRADE) guidelines and the Cochrane Database questionnaire. The meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Seventeen studies were included, with a total of 1505 knees receiving a mobile bearing TKA and 1550 knees receiving a fixed bearing TKA. The meta-analysis compared clinical outcomes between mobile bearing (MB)-TKA and fixed bearing (FB)-TKA using postoperative Knee Society Score, postoperative ROM, and survivorship and showed that there was a distinct difference in Knee Society Score between the mobile-bearing and fixed-bearing groups (overall standardized mean difference = 1.38; 95% confidence interval (CI): 0.50-2.25; p = 0.002; I2 = 60%). Patients treated with mobile-bearing prostheses were more likely to report good or excellent range of motion results (overall standardized mean difference = 2.06; 95% CI: 0.65-3.47; p = 0.004). No difference in implant survivorship or reoperation rate were identified. The fixed-bearing and mobile-bearing TKA designs are both capable of producing excellent long-term results with excellent clinical outcomes if properly implanted; however, the mobile-bearing TKA have superiority in mid- to long-term clinical results. Trial registration number for PROSPERO was CRD42019126402.
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Affiliation(s)
- Kaiyang Wang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Fang Fang Zhang
- Department of Orthopedic Surgery, Tongji University School of Medicine, Tongji Hospital, Shanghai, China
| | - Xu Yan
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yifan Shen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weijie Cai
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiaming Xu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiong Mei
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Hao D, Wang J. Fixed-bearing vs mobile-bearing prostheses for total knee arthroplasty after approximately 10 years of follow-up: a meta-analysis. J Orthop Surg Res 2021; 16:437. [PMID: 34229702 PMCID: PMC8259014 DOI: 10.1186/s13018-021-02560-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/15/2021] [Indexed: 12/11/2022] Open
Abstract
Background The benefits and risks of fixed-bearing and mobile-bearing designs for total knee arthroplasty (TKA) were compared, and long-term functional, clinical and radiological outcomes were analysed. Methods A comprehensive search in the PubMed, EMBASE, Web of Science and Cochrane Central databases was conducted to identify randomized controlled trials (RCTs) comparing fixed-bearing and mobile-bearing designs with no less than 9 years of follow-up. Primary outcome measures were Knee Society Scores (KSSs), range of motion (ROM) in knee joint values, complication rates and revision rates. The final search was performed on 23 April 2021. Results Six RCTs were included. A total of 451 patients with 612 knees met the inclusion criteria. The mobile-bearing design, in contrast to the fixed-bearing design, can clearly increase the KSFSs, especially with posterior cruciate retention. There was no significant difference in the KSKSs, ROM values, revision rates or complication rates between the two bearing design groups. Conclusion After approximately 10 years of follow-up, the mobile-bearing design has advantages in KSFSs over the fixed-bearing design. The mobile-bearing design may also have advantages in the revision rates over the fixed-bearing design when the posterior cruciate ligament is substituted. There may be no clear difference in KSKSs, ROM values or complication rates between these two designs.
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Affiliation(s)
- Dongsheng Hao
- Shanxi Bethune Hospital, Shanxi Academy of Medical Science, No. 99, Longcheng Street, Taiyuan, 030032, Shanxi Province, China.
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Hantouly AT, Ahmed AF, Alzobi O, Toubasi A, Salameh M, Elmhiregh A, Hameed S, Ahmed GO, Alvand A, Al Dosari MAA. Mobile-bearing versus fixed-bearing total knee arthroplasty: a meta-analysis of randomized controlled trials. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:481-495. [PMID: 34021791 PMCID: PMC8924090 DOI: 10.1007/s00590-021-02999-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/09/2021] [Indexed: 11/24/2022]
Abstract
Objective The purpose of this study was to perform a meta-analysis comparing mobile-bearing with fixed-bearing total knee arthroplasty (TKA) in terms of all-cause revision rates, aspetic loosening, knee functional scores, range of motion and radiographic lucent lines and osteolysis. Methods PubMed, Cochrane Library, Google Scholar and Web of Science were searched up to January 2020. Randomized controlled trials that compared primary mobile-bearing with fixed-bearing TKA, reporting at least one of the outcomes of interest, at a minimum follow-up of 12 months were included. All outcomes of interest were pooled at short-term (< 5 years), mid-term (5 to 9 years) and long-term (> = 10 years) follow-up intervals. Results A total of 70 eligible articles were included in the qualitative and statistical analyses. There was no difference between mobile-bearing or fixed-bearing TKA at short-term, mid-term and long-term follow-ups in all outcome measures including all-cause revision rate, aseptic loosening, oxford knee score, knee society score, Hospital for Special Surgery score, maximum knee flexion, radiographic lucent lines and radiographic osteolysis. Conclusion The current level of evidence demonstrated that both mobile-bearing and fixed-bearing designs achieved excellent outcomes, yet it does not prove the theoretical advantages of the mobile-bearing insert over its fixed-bearing counterpart. The use of either design could therefore be supported based on the outcomes assessed in this study. Level of Evidence: Level II, Therapeutic Supplementary information The online version contains supplementary material available at (10.1007/s00590-021-02999-x).
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Affiliation(s)
- Ashraf T Hantouly
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Abdulaziz F Ahmed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
| | - Osama Alzobi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ammar Toubasi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Motasem Salameh
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Aissam Elmhiregh
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Shamsi Hameed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ghalib O Ahmed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Affiliation(s)
- Fares S Haddad
- The Bone & Joint Journal, Professor of Orthopaedic Surgery, University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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Sappey-Marinier E, de Abreu FGA, O'Loughlin P, Gaillard R, Neyret P, Lustig S, Servien E. No difference in patellar position between mobile-bearing and fixed-bearing total knee arthroplasty for medial osteoarthritis: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2020; 28:1542-1550. [PMID: 31218390 DOI: 10.1007/s00167-019-05565-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/12/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE Total knee arthroplasty (TKA) is the treatment of choice for severe osteoarthritis of the knee. Many studies have been performed comparing mobile- and fixed-bearing designs; however, there are insufficient data regarding the patellar position in either system. This study aimed to compare the resultant patellar position with a mobile- versus a fixed-bearing TKA and the influence of both designs on clinical outcomes. MATERIALS AND METHODS In this prospective randomized study, between 2007 and 2009, 160 TKA patients were assessed; 79 received a mobile-bearing and 81 received a fixed-bearing implant, for medial compartment osteoarthritis. A posteriorly stabilized, HLS Noetos knee prosthesis (Tornier, Saint-Ismier, France) was used in all cases. The only difference between the groups was whether the tibial component incorporated a fixed or mobile bearing. The patella was resurfaced in all cases. The International Knee Society Score (KSS) and the patellar tilt and translation were compared post-operatively. Patellar translation and patellar tilt analyses were subdivided into two subgroups (< 5 mm vs > 5 mm and < 5° vs > 5°). RESULTS The KSS was not statistically different between the groups at a mean follow-up of 7.4 years (range 5-11 years). Patellar translation and patellar tilt were not statistically different between the groups. When considering the patellar translation subgroup analysis, a significantly increased risk of patellar translation, greater than 5 mm, was found in the mobile-bearing group compared to fixed-bearing group (OR = 2.3; p = 0.048) without generating any meaningful difference in clinical outcomes. CONCLUSION The theoretical advantages of mobile-bearing implants compared to fixed-bearing implants were not demonstrated in this randomized study, at mid-term follow-up. In daily practice, the choice between mobile-bearing and fixed-bearing designs should be based on the experience and clinical judgment of the surgeon. LEVEL OF EVIDENCE Prospective randomized study, level I.
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Affiliation(s)
- Elliot Sappey-Marinier
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France.
| | - Felipe Galvão A de Abreu
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
- Orthopaedic Department, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Padhraig O'Loughlin
- Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - Romain Gaillard
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
| | - Philippe Neyret
- Clinique Genolier, 3 route du muids, 1272, Genolier, Switzerland
| | - Sebastien Lustig
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - Elvire Servien
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
- LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
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Chalmers BP, Mehrotra KG, Sierra RJ, Pagnano MW, Taunton MJ, Abdel MP. Reliable outcomes and survivorship of primary total knee arthroplasty for osteonecrosis of the knee. Bone Joint J 2019; 101-B:1356-1361. [PMID: 31674235 DOI: 10.1302/0301-620x.101b11.bjj-2019-0576.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Knee osteonecrosis in advanced stages may lead to joint degeneration. Total knee arthroplasty (TKA) for osteonecrosis has traditionally been associated with suboptimal results. We analyzed outcomes of contemporary TKAs for osteonecrosis, with particular emphasis on: survivorship free from aseptic loosening, any revision, and any reoperation plus the clinical outcomes, complications, and radiological results. PATIENTS AND METHODS In total, 156 patients undergoing 167 primary TKAs performed for osteonecrosis between 2004 and 2014 at a single institution were reviewed. The mean age at index TKA was 61 years (14 to 93) and the mean body mass index (BMI) was 30 kg/m2 (18 to 51) The mean follow-up was six years (2 to 12). A total of 110 TKAs (66%) were performed for primary osteonecrosis and 57 TKAs (34%) for secondary osteonecrosis. Overall, 15 TKAs (9%) had tibial stems, while 12 TKAs (7%) had femoral stems. Posterior-stabilized designs were used in 147 TKAs (88%) of TKAs. Bivariate Cox regression analysis was conducted to identify risk factors for revision and reoperation. RESULTS Survivorship free from aseptic loosening, any revision, and any reoperation at ten years was 97% (95% confidence interval (CI) 93 to 100), 93% (95% CI 85 to 100), and 82% (95% CI 69 to 93), respectively. No factors, including age, sex, BMI, primary versus secondary osteonecrosis, stem utilization, and constraint, were identified as risk factors for reoperation. Four TKAs (2%) underwent revision, most commonly for tibial aseptic loosening (n = 2). Excluding revisions and reoperations, there was a total of 11 complications (7%), with the most common being a manipulation under anaesthesia (six TKAs, 4%). Mean Knee Society Scores (Knee component) significantly improved from 57 (32 to 87) preoperatively to 91 (49 to 100) postoperatively (p < 0.001). No unrevised TKAs had complete radiolucent lines or radiological evidence of loosening. CONCLUSION Contemporary cemented TKAs with selective stem utilization for osteonecrosis resulted in durable survivorship, a low complication rate, and reliable improvement in clinical outcomes. Cite this article: Bone Joint J 2019;101-B:1356-1361.
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Affiliation(s)
- Brian P Chalmers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kapil G Mehrotra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Taunton
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Does mobile-bearing have better flexion and axial rotation than fixed-bearing in total knee arthroplasty? A randomised controlled study based on gait. J Orthop Translat 2019; 20:86-93. [PMID: 31908938 PMCID: PMC6939107 DOI: 10.1016/j.jot.2019.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/28/2019] [Accepted: 07/30/2019] [Indexed: 12/31/2022] Open
Abstract
Objective To analyse the 6 degrees of freedom of the knee and gait data of patients with medial knee osteoarthritis before and after fixed-bearing (FB) and mobile-bearing (MB) total knee arthroplasty (TKA) and examine the influence of TKA on gait characteristics and the difference between FB and MB prosthesis. We also sought to explore the prosthesis options available for TKA in these patients. Methods Thirty patients who underwent TKA at the Department of Orthopedics at our hospital from June to October 2017 were included. All patients had a lower limb mechanical axis (hip-knee-ankle angle) of less than 180° which were regarded as genu varum knees and had medial knee osteoarthritis. Patients were randomised divided into the FB group and the MB group according to the knee prosthesis implanted. An infrared navigation three-dimensional portable knee motion analysis system (Opti-Knee®, Shanghai Innomotion, Inc.) was used to acquire data on the 6 degrees of freedom of both knees when walking on flat ground before and after surgery (angle of tibia relative to femur parameters: flexion-extension, internal rotation–external rotation, abduction–adduction; displacement parameters: anterior–posterior, proximal–distal, medial–lateral). Postoperative follow-up efficacy was assessed using the Oxford Knee Score system. Results There were significant differences in the maximum values of the internal/external rotation and flexion/extension angle between patients post-TKA and the healthy population, p values were 0.007 and <0.001,respectively. The postoperative maximum values of genu varum and internal rotation in both FB [(−9.49 ± 5.99°), (−5.77 ± 3.42°), respectively] and MB [(−9.64 ± 4.83°), (−7.54 ± 4.51°), respectively] groups were lower than the preoperative ones [FB (−15.13 ± 6.78°), (−8.28 ± 4.83°); MB (−13.28 ± 3.98°), (−9.46 ± 4.99°), respectively] (p ≤ 0.001), while the postoperative maximum values of flexion angle and anterior displacement in both FB [(46.11 ± 4.14°), (0.71 ± 0.35 cm), respectively] and MB [(49.33 ± 3.98°), (0.75 ± 0.89 cm), respectively] groups were larger than the preoperative ones [FB (43.15 ± 3.77°), (0.26 ± 0.74 cm); MB (44.62 ± 5.92°), (0.33 ± 0.79°), respectively] (p ≤ 0.001). The postoperative range of flexion/extension angle in both FB (40.13 ± 4.14°) and MB (45.82 ± 3.76°) groups was significantly larger than the preoperative one [FB (36.17 ± 6.07°), MB (37.09 ± 3.93°), respectively] (p ≤ 0.001). There were also significant increases in range of anterior–posterior displacement in the FB group (0.85 ± 0.32 cm) postoperatively compared with the preoperative one (0.71 ± 0.92 cm) (p = 0.016) and significant increases in range of medial-lateral displacement (0.64 ± 0.73 cm) in the MB group postoperatively compared with the preoperative one (0.52 ± 0.91 cm) (p = 0.025). The mean flexion/extension angle of the MB group was significantly greater than the FB group after surgery in both the stance phase and the swing phase (p < 0.001). There were significant differences in postoperative knee axial rotation during the gait cycle between the MB and FB groups (p = 0.028) and that postoperative internal rotation of the tibia relative to the femur increased in the MB group. The Oxford Knee Score at the last follow-up visit about 7.5 months after surgery was 15.6 ± 1.3 and 15.1 ± 1.1 points for FB and MB groups, respectively. This difference was not significant (p = 0.428). Conclusions TKA can make the parameters of knee gait characteristics closer to the normal population. Medial knee osteoarthritis patients who received a MB prosthesis in TKA had better joint flexion function and axial rotation than the FB one. However, there is insufficient evidence to suggest that the MB prosthesis is a better option for patients with medial knee osteoarthritis. The translational potential of this article To date, no consensus for prosthesis selection in TKA has been established. This study found significant differences in joint flexion/extension angle and internal/external rotation during gait post-TKA surgery in medial knee osteoarthritis patients who received different prostheses. This will provide some references for prosthesis selection for a large number of genu varum patients in clinical practice.
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Affiliation(s)
- Fares S Haddad
- University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
| | - B A Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
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Nugent M, Wyatt MC, Frampton CM, Hooper GJ. Despite Improved Survivorship of Uncemented Fixation in Total Knee Arthroplasty for Osteoarthritis, Cemented Fixation Remains the Gold Standard: An Analysis of a National Joint Registry. J Arthroplasty 2019; 34:1626-1633. [PMID: 31031155 DOI: 10.1016/j.arth.2019.03.047] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/05/2019] [Accepted: 03/20/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) numbers are increasing worldwide. While cement fixation for both femoral and tibial components is commonly used, alternatives include hybrid and uncemented TKAs. This study aimed to evaluate survivorship, revision rates, and patient-reported outcomes for cemented, hybrid, and uncemented TKAs using New Zealand Joint Registry (NZJR) data. METHODS NZJR data relating to all TKAs performed during the 19 years up to the end of December 2017 were analyzed. Outcomes were assessed using prosthesis survivorship data (including reasons for revision) and Oxford scores at 6 months, 5 years, and 10 years postoperatively. RESULTS A total 96,519 primary TKAs were performed during the period examined. Most (91.5%) were fully cemented with 4.8% hybrid and 3.7% uncemented. Mean Oxford scores at 6 months were highest in cemented and lowest in uncemented TKAs (P < .001). However, this was not clinically significant. There was no difference at 5 or 10 years. Ten-year survival rates were 97%, 94.5%, and 95.8% for cemented, uncemented, and hybrid TKAs, respectively. Revision rates were 0.47, 0.74, and 0.52 per 100 component years for cemented, uncemented, and hybrid prostheses, respectively. The revision rate for uncemented prostheses compared with cemented was higher (P < .001). When stratified by age group, there were differences in survival rates between cemented and uncemented groups (P = .001) and hybrid and uncemented groups (P = .038) in patients aged <55 years; between cemented and uncemented groups in those aged 55-64 years (P = .031); and between cemented and hybrid groups in those aged >75 years (P = .004). CONCLUSION Uncemented TKAs had similar patient-reported outcomes but higher revision rates and worse survivorship compared with hybrid or fully cemented TKAs.
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Affiliation(s)
- Mary Nugent
- Department of Orthopaedic Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | - Michael C Wyatt
- MidCentral District Health Board, New Zealand and Massey University, Palmerston North, Manawatu, New Zealand
| | | | - Gary J Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
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Chalmers BP, Limberg AK, Tibbo ME, Perry KI, Pagnano MW, Abdel MP. Total Knee Arthroplasty After High Tibial Osteotomy Results in Excellent Long-Term Survivorship and Clinical Outcomes. J Bone Joint Surg Am 2019; 101:970-978. [PMID: 31169573 DOI: 10.2106/jbjs.18.01060] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Some prior reports of total knee arthroplasty after high tibial osteotomy have shown high rates of aseptic loosening. As such, the goal of this study was to analyze the outcomes of contemporary total knee arthroplasty after high tibial osteotomy, with particular emphasis on survivorship free from aseptic loosening, any revision, and any reoperation; complications; radiographic results; and clinical outcomes. METHODS We retrospectively reviewed 207 patients who underwent 231 total knee arthroplasties using cemented prostheses after high tibial osteotomy from 2000 to 2012 through our total joint registry: 87% were after a closing-wedge osteotomy and 13% were after an opening-wedge osteotomy. The mean follow-up from total knee arthroplasty was 8 years. At the time of the total knee arthroplasty, the mean age was 64 years and the mean body mass index was 31 kg/m. The majority of total knee arthroplasties had a posterior-stabilized design (93%), and 4% had a varus-valgus constraint design. Tibial stems were utilized in 8% of cases. Bivariate and multivariate Cox regression analyses were utilized to analyze risk factors for poorer survival. RESULTS At 10 years, survivorship free from aseptic loosening was 97%, survivorship free from any revision was 90%, and survivorship free from any reoperation was 85%. Fifteen patients (15 total knee arthroplasties [6%]) underwent aseptic revision, most commonly for instability (3%), aseptic loosening (2%), and periprosthetic fracture (1%). On bivariate analysis, patient age of <60 years was a significant risk factor for poorer revision-free survival (hazard ratio, 2.9; p = 0.02); on multivariate analysis, younger age was the only significant risk factor for revision (p = 0.04). There were 14 complications (6%), the most common being a manipulation under anesthesia in 9 cases (4%). No unrevised total knee arthroplasties had definitive radiographic evidence of loosening. Knee Society scores improved from a mean preoperative score of 59 points to a mean postoperative score of 93 points (p < 0.001). CONCLUSIONS Contemporary total knee arthroplasty with a cemented prosthesis after high tibial osteotomy demonstrated excellent long-term durability, with 10-year survivorship free from aseptic loosening of 97%. There was reliable improvement in clinical outcomes, but perfect knee balance was sometimes challenging, as reflected by a 4% prevalence of manipulation under anesthesia and a 3% prevalence of revision for instability. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Brian P Chalmers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Afton K Limberg
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Meagan E Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kevin I Perry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Li Q, Qi X, Zhang Z. Intra-articular oxygen-ozone versus hyaluronic acid in knee osteoarthritis: A meta-analysis of randomized controlled trials. Int J Surg 2018; 58:3-10. [PMID: 30170178 DOI: 10.1016/j.ijsu.2018.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/14/2018] [Accepted: 08/20/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Knee osteoarthritis (OA) is a common disease, imposing a great burden through pain and decreased function. Numerous methods have been tested for pain management in knee OA and the optimal method is currently still under debate. We performed a meta-analysis from randomized controlled trials (RCTs) to compare the efficacy and safety of intra-articular hyaluronic acid (HA) and oxygen-ozone in the treatment of knee OA. METHODS Electronic databases included PubMed, Embase, web of science and the Cochrane Library. High quality RCTs comparing HA with oxygen-ozone in the treatment of knee OA were selected. We assessed statistical heterogeneity for each RCT with the use of a standard Chi2 test and the I2 statistic. Quality assessment was performed by using Cochrane Collaboration's tool. All data were carried out with Stata 14.0 software. RESULTS A total of four RCTs including 289 patients were included. The present meta-analysis indicated that there was a significant difference between groups regarding the visual analog scale (VAS) and WOMAC stiffness and function. The improvements in WOMAC pain were similar. No significant difference in adverse events occurrence was observed. CONCLUSION Intra-articular injection of HA was associated with a significantly reduction in VAS score at 1st month compared to oxygen-ozone. And there was significant differences in WAMAC stiffness, and function at 6-month follow-up between groups. Based on the current evidence available, more RCTs are needed for further investigation.
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Affiliation(s)
- Qingsong Li
- Department of Orthopedics, Taizhou People's Hospital, Taizhou, 225300, China
| | - Xin Qi
- Department of Bone and Joint, First Hospital of Jilin University, Changchun, 130021, China
| | - Zhenxiang Zhang
- Department of Bone and Joint, Taizhou People's Hospital, Taizhou, 225300, China.
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Abdel MP, Tibbo ME, Stuart MJ, Trousdale RT, Hanssen AD, Pagnano MW. Infographic: Fixed- versus mobile-bearing total knee arthroplasty at ten years. Bone Joint J 2018; 100-B:923-924. [PMID: 29954213 DOI: 10.1302/0301-620x.100b7.bjj-2018-0577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - M E Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - M J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - R T Trousdale
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - A D Hanssen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - M W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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