Mobile bearing total knee arthroplasty does not lead to better joint awareness compared to fixed bearing design: A systematic review and meta-analysis

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-12-15 DOI:10.1002/jeo2.70110

Mohammad Poursalehian, Yeganeh Pakbaz, Seyed Mohammad Javad Mortazavi

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Abstract

Purpose

Mobile-bearing total knee arthroplasty (MB-TKA) and fixed-bearing (FB) TKA are both widely used, with MB-TKA theoretically offering better functional outcomes due to its natural kinematics. This systematic review and meta-analysis aimed to compare joint awareness between MB-TKA and FB-TKA, as measured by Forgotten Joint Score-12 (FJS-12), to provide insights into patient-perceived outcomes.

Methods

A comprehensive literature search was conducted across major databases following PRISMA guidelines, without date or language restrictions. Studies focusing on TKA with MB or FB as the intervention and control groups, respectively, and reporting on FJS-12 were included. The selection process involved two independent reviewers. Data extraction was carried out using a structured checklist and assessed for quality using the Newcastle–Ottawa Scale (NOS). The meta-analysis employed Hedge's g method to compare FJS-12 and assessed publication bias using Egger's test and funnel plot analyses.

Results

Six studies, including two randomized clinical trials and four cohort studies with 731 participants and mean follow-up of 5.4 years, met the inclusion criteria. The meta-analysis revealed no significant difference in FJS-12 between MB and FB TKA (pooled difference = 0.132, 95% confidence interval: −0.103 to 0.367, p = 0.271), with moderate heterogeneity observed (I² = 53.5%). Publication bias assessment indicated no significant bias. Meta-regression did not identify factors contributing to heterogeneity.

Conclusion

MB-TKA does not provide superior patient-perceived outcomes in terms of joint awareness compared to FB-TKA. This suggests that the clinical advantage of MB-TKA in terms of joint awareness is likely negligible. Therefore, the choice between MB and FB TKA should be based on other considerations, such as surgeon preference, implant cost and individual patient needs.

Level of Evidence

Level III.

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与固定支座设计相比，移动支座全膝关节置换术并不会带来更好的关节知觉：系统回顾和荟萃分析。

目的：活动轴承全膝关节置换术（MB-TKA）和固定轴承全膝关节置换术（FB）均被广泛应用，MB-TKA由于其天然的运动学特性，理论上具有更好的功能效果。本系统综述和荟萃分析旨在比较MB-TKA和FB-TKA之间的关节意识，以遗忘关节评分-12 （FJS-12）衡量，以提供患者感知结果的见解。方法：根据PRISMA指南在主要数据库中进行全面的文献检索，没有日期或语言限制。纳入以MB或FB分别作为干预组和对照组的TKA研究，并报道FJS-12。评选过程由两名独立评审员参与。使用结构化检查表进行数据提取，并使用纽卡斯尔-渥太华量表（NOS）评估质量。meta分析采用Hedge’s g方法比较FJS-12，采用Egger检验和漏斗图分析评估发表偏倚。结果：6项研究符合纳入标准，包括2项随机临床试验和4项队列研究，共731名受试者，平均随访5.4年。meta分析显示，MB和FB TKA的FJS-12无显著差异（合并差异= 0.132,95%可信区间：-0.103 ~ 0.367,p = 0.271），存在中等异质性（i2 = 53.5%）。发表偏倚评估显示无显著偏倚。meta回归没有确定导致异质性的因素。结论：与FB-TKA相比，MB-TKA在关节意识方面没有提供更好的患者感知结果。这表明MB-TKA在关节意识方面的临床优势可能可以忽略不计。因此，在MB和FB TKA之间的选择应基于其他考虑因素，如外科医生的偏好、植入物的成本和患者的个体需求。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。

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