Rotating-platform TKA comparable to fixed-bearing TKA .
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(19):7 Clin Orthop Relat Res. 2014 Jul;472(7):2185-93. doi: 10.1007/s11999-014-3539-4. Epub 2014 Mar 4.17 studies were included in this meta-analysis (15 randomized controlled trials without blinding or prospective comparative studies and 2 retrospective comparative studies) comparing the outcomes of rotating-platform mobile-bearing prostheses to fixed bearing prostheses for total knee arthroplasty. Results from the meta-analyses of clinical scores, range of motion, radiographic outcome, rates of osteolysis, loosening, and progressive radiolucent lines, component alignment, adverse events, and revisions indicated no significant differences between rotating-platform and fixed-bearing designs, with the exception of tibial component alignment in the AP plane in favour of fixed-bearing design. However, this effect was small and clinically insignificant.
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Incierto = 0,5
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La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
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Introduction
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
Mobile-bearing prostheses in total knee arthroplasty (TKA) are cited to improve the biomechanics of the knee and emulate its natural kinematics, thereby reducing polyethylene wear when compared to fixed bearings. Previous meta-analyses comparing mobile- to fixed-bearing TKAs often failed to distinguish between the several mobile-bearing subgroups. Several mobile-bearing designs exist, including rotating-platform, meniscal-bearing, and AP glide-and-rotation designs. As such, this meta-analysis was performed to specifically compare mobile-bearings of the rotating-platform design to fixed-bearings designs following TKA.
¿Cuál era la pregunta principal de la investigación?
How do rotating-platform mobile-bearings compare to fixed-bearings with respect to clinical performance, component alignment, incidence of adverse events, and revision rates following total knee arthroplasty?
- No significant differences were observed between groups when a meta-analysis was performed for Knee Society Function scores in 8 studies (p=0.465), Knee Society Knee scores in 10 studies (p=0.429), Hospital for Special Surgery scores in 3 studies (p=0.510), SF-12 Physical scores in 3 studies (p=0.501), and SF-12 Mental scores in 3 studies (p=0.209).
- Range of motion for flexion contracture (4 studies), extension (3 studies), flexion (9 studies), and total range of motion (8 studies) were comparable between groups (p=0884; p=0.499; p=0.058; p=0.685; respectively).
- No between group differences were observed for radiographic evaluations for palmar tilt (3 studies; p=0.670), radiolucent lines (6 studies; p=0.348), nonprogressive radiolucent lines (3 studies; p=0.903), and tibial radiolucent lines (3 studies; p=0.538).
- Rates of radiographic osteolysis (3 cases total; rotation-platform group), radiographic loosening 2 cases total; rotation-platform group), and progressive radiolucent lines (1 case in total; fixed bearing group) were not statistically different between groups.
- Tibial component alignment in the AP plane (3 studies) favoured the fixed-bearing group (standardized mean difference, 0.229; 95% CI 0.035–0.422; p=0.020), although effect size was small and not clinically important. Femoral component alignment in the AP plane and tibial component alignment in the sagittal plane were similar between groups (3 studies each; p=0.894 and p=0.379, respectively).
- Incidence of anterior knee pain (3 studies), and stiffness requiring manipulation (4 studies) were comparable between groups (p=0.821 and p=0.326 respectively).
- Number of patients requiring revision for deep infection (3 studies; 2 revisions in fixed bearing group), loosening (3 studies; 3 cases in rotating-platform group), or for any reason (9 studies; 4 revision in each group) were not significantly difference between groups.
¿Qué es lo que más debo recordar?
Results from the meta-analyses of clinical scores, range of motion, radiographic outcome, rates of osteolysis, loosening (progressive radiolucent lines), component alignment, adverse events, and revisions indicated no significant differences between rotating-platform and fixed-bearing designs, with the exception of tibial component alignment in the AP plane in favour of fixed-bearing design. However, this effect was small and clinically insignificant.
¿Cómo afectará esto al cuidado de mis pacientes?
The findings of this study demonstrated no clinically important differences between total knee arthroplasty performed using rotating-platform mobile-bearing prostheses versus fixed-bearing prostheses. The authors recommended that future research focus on other factors that may influence outcome.
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