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

Abstract

Purpose The purpose of this study was to perform a systematic review and meta-analysis to compare clinical and patient-reported 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.

Medial pivot prosthesis has a better functional score and lower complication rate than posterior-stabilized prosthesis: a systematic review and meta-analysis

“…The WOMAC and HSS score after MP-TKA were significantly lower compared with PS-TKA, while there was no significant difference in KSS, KSFS, and OKS. Different from the previous three meta-analyses [ 12 , 14 , 15 ], we compared the position of two prosthesis. The analysis showed that the postoperative position of the prosthesis was good, and there was no significant difference.…”

“…Different from previous meta-analyses [ 12 , 14 , 15 ],we paid more attention to the postoperative complication rate and revision rate of MP-TKA and PS-TKA. The study of Kim [ 21 ]et al was terminated early because of the high infection rate (6%).…”

“…Up to now, there are still disputes about the postoperative effects of the two prostheses, and only a few meta-analyses have analyzed these problems. No significant difference in the results of these previous analyses could be due to the fact that fewer studies or outcomes were included [ 12 – 15 ]. In particular, the complications have not been fully analyzed in these analyses.…”

Medial Pivot Designs Versus Conventional Bearing Types in Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…To our knowledge, this is the first systematic review of RCTs that compared MP designs with conventional bearings, although meta-analysis was limited to comparison with PS bearings. Other systematic reviews and meta-analyses are limited by pooling of all study designs (retrospective and prospective), inclusion of study designs with a high risk-of-bias, pooling of all conventional bearing types into one group, and heterogeneity of included patients, 8–10 such as RCTs including both primary and revision procedures. 23 Notwithstanding, those reviews support our findings of no clear difference in clinical outcomes between MP and PS bearings.…”

Loss of Knee Flexion and Femoral Rollback of the Medial-Pivot and Posterior-Stabilized Total Knee Arthroplasty During Early-Stance of Walking in Chinese Patients

“…Numerous studies reported satisfactory clinical results of MP TKA ( Hossain et al, 2011 ; Youm et al, 2014 ; Steinbruck et al, 2016 ; Gray et al, 2020 ; Jones et al, 2020 ) and patient preference over PS and other prostheses ( Schmidt et al, 2003 ; Pritchett, 2011 ). On the contrary, other authors reported that the MP design was not superior to other designs in patient-reported outcomes and knee kinematics ( Chinzei et al, 2014 ; Papagiannis et al, 2016 ; Choi et al, 2017 ; Kim et al, 2017 ; Jones et al, 2020 ; Nisar et al, 2020 ). More evidence is needed to determine the effectiveness and design specialty of the MP prosthesis.…”