反向脆性指数比较全膝关节置换术中髌骨置换和不髌骨置换的再手术率：一项随机对照试验的系统综述

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee Pub Date : 2025-05-26 DOI:10.1016/j.knee.2025.05.014

Stephen P Fucaloro , Jack T Bragg , Daniel Sun , Matthew J Salzler

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引用次数: 0

摘要

背景：全膝关节置换术（TKA）中髌骨表面置换存在争议。反向脆弱性指数（RFI1）通过确定改变非显著结果所需的最小事件数来评估研究的中立性。本研究确定了tka与不进行表面修复的tka再手术无差异的研究的RFI。方法对PubMed、Embase和Web of Science数据库进行系统回顾，以确定随机对照试验（RCT），这些试验显示髌骨置换与不髌骨置换在tka再手术率上没有差异。包括再手术次数和失访患者数量。以P <为阈值计算每项研究的再手术率RFI；0.05.结果共纳入19项随机对照试验3,804例tka，其中1,813例髌骨表面修复。复盖髌骨的再手术中位数（四分位间距[IQR2]）为4.4%(0-9.1%)，保留髌骨为4.5%（0-8.3%）。RFI中位数为5，表明只有5例患者需要相反的结果才能使再手术率的差异变得显著。随访的中位（IQR）损失为8例（3-20例），63.2%（19例中的12例）的研究损失超过了他们的RFI。结论经髌骨表面置换术的tka再手术率与不经髌骨表面置换术的tka再手术率无显著差异的rct在统计学上是脆弱的。只有少数结果发生逆转，这种差异才会变得显著，而在大多数研究中，这一数字小于一项研究的随访损失。

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Reverse fragility index comparing rates of reoperation in total knee arthroplasty with and without patellar resurfacing: a systematic review of randomized controlled trials

Background

Patellar resurfacing during total knee arthroplasty (TKA) is debated. The reverse fragility index (RFI¹) assesses study neutrality by determining the minimum number of events needed to change non-significant results, significant. This study determined the RFI for studies showing no difference in reoperation between TKAs with and without resurfacing.

Methods

A systematic review of PubMed, Embase, and Web of Science databases was conducted to identify randomized controlled trials (RCT) showing no difference in reoperation rates between TKAs with and without patellar resurfacing. The number of reoperations and the number of patients lost to follow-up were included. The RFI was calculated for reoperation rate of each study with a threshold of P < 0.05.

Results

Nineteen RCTs with 3,804 TKAs were included, 1,813 of which resurfaced the patella. The median (interquartile range [IQR²]) reoperation rate was 4.4% (0–9.1%) in resurfaced patellae, and 4.5% (0–8.3%) in retained patellae. The median RFI was five, indicating that only five patients would need the opposite outcome for the difference in reoperation rate to become significant. The median (IQR) loss to follow-up was eight (3–20) patients, and 63.2% (12 of 19) of studies had loss that exceeded their RFI.

Conclusion

Most RCTs showing no difference in reoperation rate between TKAs with or without patellar resurfacing are statistically fragile. Difference in rates can become significant with the reversal of only a few outcomes, and this number was less than a study’s loss to follow-up in most studies.

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来源期刊

Knee 医学-外科

CiteScore

3.80

自引率

5.30%

发文量

171

审稿时长

6 months

期刊介绍： The Knee is an international journal publishing studies on the clinical treatment and fundamental biomechanical characteristics of this joint. The aim of the journal is to provide a vehicle relevant to surgeons, biomedical engineers, imaging specialists, materials scientists, rehabilitation personnel and all those with an interest in the knee. The topics covered include, but are not limited to: • Anatomy, physiology, morphology and biochemistry; • Biomechanical studies; • Advances in the development of prosthetic, orthotic and augmentation devices; • Imaging and diagnostic techniques; • Pathology; • Trauma; • Surgery; • Rehabilitation.