Mohammad Poursalehian, Sina Hajiaghajani, Ali S. Farsani, Christian J. Hecht, Atul F. Kamath
{"title":"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。","authors":"Mohammad Poursalehian, Sina Hajiaghajani, Ali S. Farsani, Christian J. Hecht, Atul F. Kamath","doi":"10.1002/ksa.12749","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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, <i>p</i> < 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 (<i>I</i>² = 60%), with a pooled HR of 1.70 (95% CI: 1.28–2.27, <i>p</i> < 0.001). No publication bias was detected, and sensitivity analyses confirmed the robustness of the results.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>Level III.</p>\n </section>\n </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 10","pages":"3654-3664"},"PeriodicalIF":5.0000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"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\",\"authors\":\"Mohammad Poursalehian, Sina Hajiaghajani, Ali S. Farsani, Christian J. Hecht, Atul F. Kamath\",\"doi\":\"10.1002/ksa.12749\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Purpose</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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, <i>p</i> < 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 (<i>I</i>² = 60%), with a pooled HR of 1.70 (95% CI: 1.28–2.27, <i>p</i> < 0.001). 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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.
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).