Sina Hajiaghajani, Omid Bahrami, Mohammadhossein Hefzosseheh, Maryam Alaei, Amir Mehrvar, Mohammad Poursalehian
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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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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. 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引用次数: 0
摘要
背景：全膝关节置换术（TKA）中髌骨构件的设计可以影响髌骨股骨运动学和临床结果。中间圆顶设计（MDD）使髌骨尖端更向内侧对齐，而解剖髌骨设计（APD）旨在复制原始髌骨的形状和轨迹。尽管生物力学研究表明APD的潜在益处，但临床证据仍不确定。方法：根据PRISMA指南进行系统回顾和荟萃分析，比较现代后稳定TKA （ATTUNE系统）中MDD和APD的临床结果。我们在2025年1月10日检索PubMed， Scopus， Embase和Web of Science，没有语言和日期限制。符合条件的研究包括随机对照试验（rct）和比较队列设计，评估患者报告的结果测量（PROMs）、修正、并发症、活动范围（ROM）和髌骨稳定性的放射学测量。随机对照试验采用rob2评估偏倚风险，队列研究采用robins - 1评估偏倚风险。使用Hedges's g和随机效应模型计算合并效应大小。结果：纳入了7项研究，包括3项随机对照试验和4项队列研究，共纳入1069例患者和1113个膝关节（507例APD对606例MDD）。meta分析显示，两组学生的prom无显著差异(Hedges’s g = 0.09；95% CI [-0.04 ~ 0.22]；P = 0.17)或ROM (Hedges’s g = 0.02；95% CI [-0.21 ~ 0.26]；P = 0.83)。虽然APD的翻修率和并发症更高，但与MDD相比差异无统计学意义（14比9）。放射测量显示不一致，并没有明确支持任何一种设计。结论：目前的证据表明，在ATTUNE后稳定TKA中，APD没有明显优于MDD的临床优势。两种设计产生的PROMs和膝关节功能结果大致相当。为了明确APD的安全性，有必要进行更大规模的随机对照试验，并延长随访时间。证据水平：III。
"Anatomic patella design versus medialized dome design in the modern posterior stabilized (ATTUNE) total knee arthroplasty: a systematic review and meta-analysis".
Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
期刊介绍：
Journal of Orthopaedic Surgery and Research is an open access journal that encompasses all aspects of clinical and basic research studies related to musculoskeletal issues.
Orthopaedic research is conducted at clinical and basic science levels. With the advancement of new technologies and the increasing expectation and demand from doctors and patients, we are witnessing an enormous growth in clinical orthopaedic research, particularly in the fields of traumatology, spinal surgery, joint replacement, sports medicine, musculoskeletal tumour management, hand microsurgery, foot and ankle surgery, paediatric orthopaedic, and orthopaedic rehabilitation. The involvement of basic science ranges from molecular, cellular, structural and functional perspectives to tissue engineering, gait analysis, automation and robotic surgery. Implant and biomaterial designs are new disciplines that complement clinical applications.
JOSR encourages the publication of multidisciplinary research with collaboration amongst clinicians and scientists from different disciplines, which will be the trend in the coming decades.
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