Comprehensive evaluation of risk factors for aseptic loosening in cemented total knee arthroplasty: A systematic review and meta-analysis

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-07-21 DOI:10.1002/jeo2.12095

Kaiyi Yao, Yao Chen

{"title":"Comprehensive evaluation of risk factors for aseptic loosening in cemented total knee arthroplasty: A systematic review and meta-analysis","authors":"Kaiyi Yao, Yao Chen","doi":"10.1002/jeo2.12095","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>Aseptic loosening is the most common cause for revisions after total knee arthroplasty (TKA). Despite many studies exploring various risk factors associated with aseptic loosening, findings often present inconsistencies. To address this, we conducted a thorough review of the literature to identify and analyse these risk factors in cemented TKA. Additionally, we performed a meta-analysis to reconcile the divergent conclusions observed across studies.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We searched PubMed, Web of Science and Embase from 1996 up to 2024 and evaluated the quality of the included literature. Seventy-four studies were included to assess the association of BMI, diabetes, high physical activity (HPA), osteoporosis, rheumatoid arthritis (RA), cement material and implant design. Twenty-nine studies were used to calculate relative risk and CIs (using the random effects theory) and study heterogeneity for six different risk factors (BMI, diabetes, HPA level, cement material, polyethylene and implant design).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Patients with diabetes are eight times more likely to experience aseptic loosening compared to those without diabetes (RR = 9.18, 95% CI: 1.80−46.77, <i>p</i> < 0.01). The use of tibial stem extension or highly crosslinked polyethylene can help reduce the incidence of aseptic loosening. However, we did not identify BMI, HPA, osteoporosis, RA, the use of high-viscosity cement and the utilization of mobile-bearing designs as risk factors for aseptic loosening post-cemented TKA.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Patients with diabetes undergoing TKA should be counselled regarding their potential increased risk of aseptic loosening. The use of tibial stem extensions and HXLPE can mitigate the incidence of aseptic loosening in cemented TKA. However, given a limited number of studies were included in the meta-analysis, we believe that higher-level studies are necessary to clearly identify other risk factors.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>Level III.</p>\n </section>\n </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 3","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11260281/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Experimental Orthopaedics","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jeo2.12095","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose

Aseptic loosening is the most common cause for revisions after total knee arthroplasty (TKA). Despite many studies exploring various risk factors associated with aseptic loosening, findings often present inconsistencies. To address this, we conducted a thorough review of the literature to identify and analyse these risk factors in cemented TKA. Additionally, we performed a meta-analysis to reconcile the divergent conclusions observed across studies.

Methods

We searched PubMed, Web of Science and Embase from 1996 up to 2024 and evaluated the quality of the included literature. Seventy-four studies were included to assess the association of BMI, diabetes, high physical activity (HPA), osteoporosis, rheumatoid arthritis (RA), cement material and implant design. Twenty-nine studies were used to calculate relative risk and CIs (using the random effects theory) and study heterogeneity for six different risk factors (BMI, diabetes, HPA level, cement material, polyethylene and implant design).

Results

Patients with diabetes are eight times more likely to experience aseptic loosening compared to those without diabetes (RR = 9.18, 95% CI: 1.80−46.77, p < 0.01). The use of tibial stem extension or highly crosslinked polyethylene can help reduce the incidence of aseptic loosening. However, we did not identify BMI, HPA, osteoporosis, RA, the use of high-viscosity cement and the utilization of mobile-bearing designs as risk factors for aseptic loosening post-cemented TKA.

Conclusions

Patients with diabetes undergoing TKA should be counselled regarding their potential increased risk of aseptic loosening. The use of tibial stem extensions and HXLPE can mitigate the incidence of aseptic loosening in cemented TKA. However, given a limited number of studies were included in the meta-analysis, we believe that higher-level studies are necessary to clearly identify other risk factors.

Level of Evidence

Level III.

Abstract Image

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

全面评估骨水泥全膝关节置换术中无菌性松动的风险因素：系统回顾和荟萃分析。

目的：无菌性松动是全膝关节置换术（TKA）后最常见的翻修原因。尽管有许多研究探讨了与无菌性松动相关的各种风险因素，但研究结果往往不一致。为了解决这个问题，我们对文献进行了全面的回顾，以确定和分析骨水泥 TKA 中的这些风险因素。此外，我们还进行了一项荟萃分析，以调和各研究中观察到的不同结论：我们检索了从 1996 年到 2024 年的 PubMed、Web of Science 和 Embase，并对纳入文献的质量进行了评估。共纳入74项研究，以评估体重指数（BMI）、糖尿病、高体力活动（HPA）、骨质疏松症、类风湿性关节炎（RA）、骨水泥材料和种植体设计之间的关联。29项研究用于计算六种不同风险因素（体重指数、糖尿病、HPA水平、骨水泥材料、聚乙烯和植入体设计）的相对风险和CIs（使用随机效应理论）以及研究异质性：结果：糖尿病患者发生无菌性松动的几率是非糖尿病患者的八倍（RR = 9.18，95% CI：1.80-46.77，P 结论：接受 TK 的糖尿病患者发生无菌性松动的几率是非糖尿病患者的八倍（RR = 9.18，95% CI：1.80-46.77，P）：接受TKA手术的糖尿病患者应就其无菌性松动潜在增加的风险接受咨询。在骨水泥TKA中使用胫骨柄延长和HXLPE可降低无菌性松动的发生率。然而，鉴于纳入荟萃分析的研究数量有限，我们认为有必要进行更高级别的研究，以明确其他风险因素：证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊