与金属支撑的单室膝关节置换术相比,全聚乙烯胫骨假体与失败率增加有关:一项对34,647名重构个体化患者数据的荟萃分析。

IF 5 2区 医学 Q1 ORTHOPEDICS
Mohammad Poursalehian, Sina Hajiaghajani, Ali S. Farsani, Christian J. Hecht, Atul F. Kamath
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引用次数: 0

摘要

目的:在单室膝关节置换术(UKA)中,全聚乙烯(AP)与金属支撑(MB)胫骨假体的比较生存率尚不清楚,因为之前的研究主要使用相对风险,没有全面的事件时间分析。方法:遵循PRISMA指南,进行系统评价和荟萃分析。检索数据库(PubMed, Scopus, Embase和Web of Science)没有限制。纳入的研究比较了UKA的MB和AP胫骨成分。使用robins - 1和robins -2工具评估偏倚风险。风险比(hr)由Kaplan-Meier数据重建得出。分析采用IPD重建(Log-rank检验)和meta分析方法。结果:在筛选了2577项记录后,18项研究包括35,639个膝关节(21,610 MB;14,029 AP)被纳入。11项研究发现生存率无差异,6项支持MB, 1项支持AP。然而,34,647个膝关节的汇总IPD分析显示MB的生存优势(AP与MB的HR = 1.55, 95%可信区间[CI]: 1.45-1.65, p)结论:固定轴承UKA中MB胫骨组件与AP组件相比具有更低的修复风险。尽管关于确切失效时间和种植体设计变化的数据有限,但研究结果表明,固定轴承UKA中的AP组件不太有利。证据等级:三级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

All-polyethylene tibial components are associated with an increased rate of failure compared to metal-backed unicompartmental knee arthroplasty: A meta-analysis of 34,647 reconstructed individualised patient data

All-polyethylene tibial components are associated with an increased rate of failure compared to metal-backed unicompartmental knee arthroplasty: A meta-analysis of 34,647 reconstructed individualised patient data

Purpose

The comparative survivorship of all-polyethylene (AP) versus metal-backed (MB) tibial components in unicompartmental knee arthroplasty (UKA) remains unclear, as previous studies mainly used relative risk without comprehensive time-to-event analysis.

Methods

Following PRISMA guidelines, a systematic review and meta-analysis were performed. Databases (PubMed, Scopus, Embase and Web of Science) were searched without restrictions. Included studies compared MB and AP tibial components in UKA. Risk of bias was assessed using ROBINS-I and RoB-2 tools. Hazard ratios (HRs) were derived from reconstructed Kaplan–Meier data. Analyses used both IPD reconstruction (Log-rank test) and meta-analysis methods.

Results

After screening 2577 records, 18 studies comprising 35,639 knees (21,610 MB; 14,029 AP) were included. Eleven studies found no difference in survivorship, six favoured MB and one favoured AP. However, pooled IPD analysis of 34,647 knees showed a survival advantage for MB (HR for AP vs. MB = 1.55, 95% confidence interval [CI]: 1.45–1.65, p < 0.0001). Revision rates at 2, 5 and 10 years were lower for MB (3.0%, 5.9% and 11.1%) compared to AP (4.4%, 9.2% and 17.2%). Aseptic loosening was the most common cause of failure, typically occurring after 5 years of implantation. The meta-analysis of reconstructed HRs indicated moderate-to-high heterogeneity (I² = 60%), with a pooled HR of 1.70 (95% CI: 1.28–2.27, p < 0.001). No publication bias was detected, and sensitivity analyses confirmed the robustness of the results.

Conclusions

MB tibial components in fixed-bearing UKA show a lower risk of revision compared to AP components. Despite limited data on exact failure times and variations in implant design, the findings suggest that AP components in fixed-bearing UKA are less favourable.

Level of Evidence

Level III.

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来源期刊
CiteScore
8.10
自引率
18.40%
发文量
418
审稿时长
2 months
期刊介绍: Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).
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