Medial stabilised total knee arthroplasty achieves comparable clinical outcomes when compared to other TKA designs: a sy
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KNEE
Medial stabilised total knee arthroplasty achieves comparable clinical outcomes when compared to other TKA designs: a systematic review and meta‑analysis of the current literature Sohail Nisar1,4 · Kashif Ahmad2 · Jeya Palan3 · Hemant Pandit1,4 · Bernard van Duren1,4 Received: 20 July 2020 / Accepted: 27 October 2020 © The Author(s) 2020
Abstract Purpose The purpose of this study was to perform a systematic review and meta-analysis to compare clinical and patientreported outcome measures of medially stabilised (MS) TKA when compared to other TKA designs. Methods The Preferred Reporting Items for Systematic Review and Meta-Analyses algorithm was used. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and EMCARE databases were searched to June 2020. Studies with a minimum of 12 months of follow-up comparing an MS TKA design to any other TKA design were included. The statistical analysis was completed using Review Manager (RevMan), Version 5.3. Results The 22 studies meeting the inclusion criteria included 3011 patients and 4102 TKAs. Overall Oxford Knee Scores were significantly better (p = 0.0007) for MS TKA, but there was no difference in the Forgotten Joint Scores (FJS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS)-Knee, KSS-Function, and range of motion between MS and non-MS TKA designs. Significant differences were noted for sub-group analyses; MS TKA showed significantly worse KSS-Knee (p = 0.02) and WOMAC (p = 0.03) scores when compared to Rotating Platform (RP) TKA while significantly better FJS (p = 0.002) and KSS-knee scores (p = 0.0001) when compared to cruciate-retaining (CR) TKA. Conclusion This review and meta-analysis show that MS TKA designs result in both patient and clinical outcomes that are comparable to non-MS implants. These results suggest implant design alone may not provide further improvement in patient outcome following TKA, surgeons must consider other factors, such as alignment to achieve superior outcomes. Level of evidence III. Keywords Total knee replacement · Total knee arthroplasty · Medial pivoting · Medial stabilised
Introduction Knee kinematics are driven by a complex interaction of the tibiofemoral and patellofemoral joints with the supporting passive and active soft-tissue structures. Following Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00167-020-06358-x) contains supplementary material, which is available to authorized users. * Sohail Nisar [email protected] 1
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
2
Bradford Royal Infirmary, Bradford, UK
3
Leeds Teaching Hospitals NHS Trust, Leeds, UK
4
Academic Department of Trauma and Orthopaedics, Leeds General Infirmary, University of Leeds, Leeds, UK
total knee arthroplasty (TKA), it has been shown that the kinematics of the knee are different from what is seen in the native undiseased knee [2, 20]
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