TKA: Better implant stability but comparable functionality with HA-coated tibial implants .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):32 Acta Orthop. 2011 Aug;82(4):448-59. Epub 2011 Jun 10This systematic review and meta-analysis identified 14 trials, which included 926 evaluable total knee arthroplasties. These studies examined the effect of hydroxyapatite (HA)-coating on tibial implant durability in primary total knee arthroplasty (TKA), in comparison other forms of tibial fixation. The primary outcomes in the selected studies were durability, function, and acute adverse events. Results indicated that the functionality between the types of implants were comparable, but durability with the HA-coated tibial implant may be better than other tibial implants in patients >65 years. There were no differences in adverse events between HA coated implants and other forms of tibial fixation.
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Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
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Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
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Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
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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?
There is uncertainty on the clinical benefits of hydroxyapatite (HA)-coating in tibial components, as a part of total knee arthroplasty. HA-coatings on implants may promote greater stable fixation due to its osteoconductive properties, which promote early bone in-growth. This meta-analysis was conducted to evaluate the clinical outcomes (durability, function, and acute adverse events) in HA-coated tibial components in total knee arthroplasties.
¿Cuál era la pregunta principal de la investigación?
What are the clinical outcomes (durability, function, and acute adverse events) of hydroxyapatite (HA)-coated tibial components compared to other forms of tibial fixation in patients with knee osteoarthritis undergoing primary total knee arthroplasty measured at both short and long-term follow-up periods?
- At 2 years, tibial components coated with hydroxyapatite (HA) (porous or press-fit) without screw fixation were less likely to be unstable, compared to cemented and porous metal-backed tibial components (RR=0.58, 95%CI: 0.34-0.98; p=0.04, I2 = 39%, M-H random effects model)
- No significant difference was seen in adverse events between groups (RR=1.20, 95%CI: 0.63-2.28; p=0.58; I2 =0%; Mantel-Haenszel (M-H) fixed effects model)
- Evaluation at 2, and 8-10 years indicated no significant difference in durability between groups.
- No significant difference was seen in functional status at 2 and 5 years, regardless of the type of measure used.
¿Qué es lo que más debo recordar?
Hydroxyapatite (HA)-coated implants may provide better implant stability in patients with osteoarthritis undergoing primary total knee arthroplasty (TKA), who are within the age range of 65-70 years, which may lead to a reduction in the need for revision later in the implant life. No difference was apparent in functionality between the HA-coated and other tibial implants, when measured by different validated scoring systems. No significant difference was seen in adverse events between groups.
¿Cómo afectará esto al cuidado de mis pacientes?
Trials with a larger population should be performed to determine the long-term outcomes of HA-coated implants and other porous-coated tibial implants, in younger (<65 years) and more active individuals with osteoarthritis.
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