Meta-analysis of limb and prosthesis alignment restoration after navigated total knee arthroplasty versus conventional total knee arthroplasty

doi:10.3969/j.issn.2095-4344.2014.35.023

Abstract

Abstract:

BACKGROUND: Computer-assisted navigation technique has been widely applied in total knee arthroplasty. However, whether computer-assisted navigation total knee arthroplasty is better than traditional total knee arthroplasty remains unclear.
OBJECTIVE: To systemically evaluate and compare the limb and prosthesis alignment restoration post computer-assisted navigation and traditional total knee arthroplasty.
METHODS: The PubMed/Medline, EMBASE, Cochrane CENTRAL, ScienceDirect database were searched from established to June 2013 and the randomized controlled trials about computer-assisted navigation and traditional total knee arthroplasty were selected. Meta analysis was performed with Rev Man 5.2 software. The evaluating data included the hip-knee-ankle mechanical axis or tibiofemoral angle, femoral prosthesis coronal angle, femoral prosthesis sagittal angle, tibial prosthesis coronal angle, and tibial prosthesis sagittal angle. The malalignment was defined as a deviation 2° or 3° from the natural line.
RESULTS AND CONCLUSION: 19 randomized controlled trials involving 2 654 cases (3 392 knees) were included in this study. Meta-analysis showed that, the limb alignment restoration post computer-assisted navigation was significantly better than traditional total knee arthroplasty (3°, P < 0.000 01 and 2°, P=0.000 8). The 3° of femoral prosthesis coronal angle deviation post computer-assisted navigation was significantly superior to traditional total knee arthroplasty (P=0.002), while the 2° deviation had no significant difference between the two surgeries (P=0.290). The 3° deviation of femoral prosthesis sagittal angle post computer-assisted navigation was significantly better than traditional total knee arthroplasty (P=0.040); however, the 2° deviation had no significant difference between the two surgeries (P=0.950). 3° and 2°tibial prosthesis coronal angle deviation post computer-assisted navigation was significantly superior to traditional total knee arthroplasty (3°, P=0.030); the 2° deviation had no significant difference between the two surgeries (P=0.260). Computer-assisted navigation has better limb alignment, femoral and tibial prosthesis alignment 3° deviation than the traditional total knee arthroplasty, but the 2° deviation of femoral prosthesis coronal angle, femoral prosthesis sagittal angle, and tibial prosthesis sagittal angle had no significant difference between the two surgeries.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: arthroplasty, replacement, knee, computer, meta-analysis

CLC Number:

R318

Wang Zeng-liang, Zhao Li, Zhao Jia-guo . Meta-analysis of limb and prosthesis alignment restoration after navigated total knee arthroplasty versus conventional total knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(35): 5707-5714.

Figures/Tables 3

2.3 全膝关节置换后股骨假体冠状角恢复情况比较的Meta分析结果见图2。以偏倚3°为标准：共11个随机对照试验报道了全膝关节置换后股骨假体冠状角偏倚3°情况，导航全膝关节置换组1 342膝，传统全膝关节置换组1 249膝，偏倚位于3°以内发生率分别为90.31%和86.79%，各研究间存在统计学异质性(P=0.000 5，I2=68%)，随机效应Meta分析表明导航组全膝关节置换后股骨假体冠状角恢复精确率明显优于传统全膝关节置换[RR=1.07，95%CI(1.01-1.13)，P=0.002]。以偏倚2°为标准：共3个随机对照试验报道了全膝关节置换后下肢机械轴偏倚2°情况，导航全膝关节置换组390膝，传统全膝关节置换组295膝，偏倚2°以内发生率分别为70.26%和60.68%，各研究间存在统计学异质性(P=0.002，I2=74%)，随机效应Meta分析表明导航组全膝关节置换后股骨假体冠状角恢复精确率和传统全膝关节置换差异无显著性意义[RR=1.12，95%CI(0.91-1.39)，P=0.290]。 Meta分析结果稳定，倒漏斗图显示基本对称。 2.4 全膝关节置换后股骨假体矢状角恢复情况比较的Meta分析结果见图3。以偏倚3°为标准：共7个随机对照试验报道了全膝关节置换后股骨假体矢状角偏倚3°情况，导航全膝关节置换组861膝，传统全膝关节置换组861膝，偏倚3°以内发生率分别为85.37%和80.37%，各研究间存在统计学异质性(P < 0.000 1，I2=79%)，随机效应Meta分析表明导航组全膝关节置换后股骨假体矢状角恢复精确率明显优于传统全膝关节置换[RR=1.15，95% CI(1.01-1.13)，P=0.040]。以偏倚2°为标准：共2个随机对照试验报道了全膝关节置换后股骨假体矢状角偏倚2°情况，导航全膝关节置换组108膝，传统全膝关节置换组110膝，偏倚位于2°以内发生率分别为60.19%和64.55%，各研究间存在统计学异质性(P=0.110，I2=62%)，随机效应Meta分析表明导航组全膝关节置换后股骨假体矢状角恢复精确率和传统全膝关节置换差异无显著性意义[RR=0.99，95%CI(0.68-1.43)，P=0.950]。 Meta分析结果稳定，倒漏斗图显示基本对称。"

2.5 全膝关节置换后胫骨假体冠状角恢复情况比较的Meta分析结果见图4。以偏倚3°为标准：共12个随机对照试验报道了全膝关节置换后胫骨假体冠状角偏倚3°情况，导航全膝关节置换组1 374膝，传统全膝关节置换组1 281膝，偏倚3°以内发生率分别为91.85%和85.56%，各研究间存在统计学异质性(P=0.003，I2=62%)，随机效应Meta分析表明导航组全膝关节置换后胫骨假体冠状角恢复精确率明显优于传统全膝关节置换[RR=1.08，95%CI(1.03-1.13)，P=0.000 7]。以偏倚2°为标准：共4个随机对照试验报道了全膝关节置换后胫骨假体冠状角偏倚2°情况，导航全膝关节置换组422膝，传统全膝关节置换组327膝，偏倚2°以内发生率分别为74.64%和57.49%，各研究间存在统计学异质性(P=0.01，I2=71%)，随机效应Meta分析表明导航组全膝关节置换后胫骨假体冠状角恢复精确率明显优于传统全膝关节置换[RR=1.36，95%CI(1.12-1.64)，P=0.002]，Meta分析结果稳定，倒漏斗图显示基本对称。 2.6 全膝关节置换后胫骨假体矢状角恢复情况比较的Meta分析结果见图5。以偏倚3°为标准：共10个随机对照试验报道了全膝关节置换后胫骨假体矢状角偏倚3°情况，导航全膝关节置换组1 060膝，传统全膝关节置换组1 064膝，偏倚3°以内发生率分别为86.60%和81.77%，各研究间存在统计学异质性(P < 0.000 1，I2=74%)，随机效应Meta分析表明导航组全膝关节置换后胫骨假体矢状角恢复精确率明显优于传统全膝关节置换[RR=1.09，95%CI(1.01-1.18)，P=0.030]。以偏倚2°为标准：共2个随机对照试验报道了全膝关节置换后胫骨假体矢状角偏倚2°情况，导航全膝关节置换组108膝，传统全膝关节置换组110膝，偏倚2°以内发生率分别为44.44%和35.45%，各研究间存在统计学异质性(P=0.150，I2=51%)，随机效应Meta分析表明导航组全膝关节置换后胫骨假体矢状角恢复精确率和传统全膝关节置换差异无显著性意义[RR=1.31，95%CI(0.82-2.09)，P=0.260]。 Meta分析结果稳定，倒漏斗图显示基本对称。"

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