ARTHROPLASTY
Hydroxyapatite (HA) coating appears to be of benefit for implant durability of tibial components in primary total knee arthroplasty
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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Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
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)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
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はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
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Introduction
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Accessing Data
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Analysing Data
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Results
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
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.
主な研究課題は何ですか？
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?
重要な知見は？
- 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.
最も覚えておくべきことは？
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.
それが私の患者ケアにどのように影響するか？
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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