Outcome of kinematic alignment using patient-specific instrumentation versus mechanical alignment in TKA: a meta-analysis and subgroup analysis of randomised trials
| Autor: | Simon W. Young, Henning Windhagen, Max Ettinger, Andrew Toms, Jason T. K. Woon, Hugh B. Waterson, Tilman Calliess, I S L Zeng |
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| Rok vydání: | 2018 |
| Předmět: |
Male
musculoskeletal diseases medicine.medical_specialty WOMAC Knee Joint Total knee arthroplasty Pain Subgroup analysis Severity of Illness Index 03 medical and health sciences 0302 clinical medicine Humans Medicine Orthopedics and Sports Medicine Arthroplasty Replacement Knee Randomized Controlled Trials as Topic 030222 orthopedics biology business.industry Arthritis 030229 sport sciences General Medicine Osteoarthritis Knee biology.organism_classification Confidence interval Biomechanical Phenomena Valgus Treatment Outcome Patient specific instrumentation Meta-analysis Orthopedic surgery Physical therapy Female Surgery Knee Prosthesis business |
| Zdroj: | Archives of Orthopaedic and Trauma Surgery. 138:1293-1303 |
| ISSN: | 1434-3916 0936-8051 |
| DOI: | 10.1007/s00402-018-2988-8 |
| Popis: | Kinematic alignment (KA) in total knee arthroplasty (TKA) matches component position to the pre-arthritic anatomy of an individual patient, with the aim of improving functional outcomes. Recent randomised controlled trials (RCTs) comparing KA to traditional neutral mechanical alignment (MA) have been mixed. This collaborative study combined raw data from RCTs, aiming to compare functional outcomes between KA using patient-specific instrumentation (PSI) and MA, and whether any patient subgroups may benefit more from KA technique. A literature search in PubMed, EMBASE and Cochrane databases identified four randomised controlled trials comparing patients undergoing TKA using PSI-KA and MA. Unpublished data including Western Ontario McMaster Universities Arthritis Index (WOMAC) and Knee Society Score (KSS) were obtained from study authors. Meta-analysis compared MA to KA change (post-op minus pre-op) scores. Subgroup-analysis on KA patients looked for subgroups more likely to benefit from KA and the impact of PSI accuracy. Meta-analyses of change scores in 229 KA patients versus 229 MA patients were no different from WOMAC (mean difference 3.4; 95% confidence interval − 0.5 to 7.3), KSS function (1.3, − 3.9 to 6.4) or KSS combined (7.2, − 0.8 to 15.2). A small advantage was seen for KSS pain in the KA group (3.6, 95% CI 0.2–7.1). Subgroup-analysis showed no difference between varus, valgus and neutral pre-operative alignment groups, and those who did and did not achieve KA plans. Pain-free patients at 1-year were more likely to achieve KA plans. Patient-reported outcome scores following TKA using PSI-KA are similar to MA. No identifiable subgroups benefited more from KA, and long-term results remain unknown. Inaccuracy of the PSI system used in KA patients could potentially affect outcome. |
| Databáze: | OpenAIRE |
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