RESUMO
Background: Kinematic alignment is an emerging approach for total knee arthroplasty, with the aim to restore patient's individual pre-arthritic joint kinematics. In this systematic review and meta-analysis, we compared the kinematic alignment with the conventional mechanical alignment for total knee arthroplasty. Methods: We searched PubMed, Web of Science, Cochrane Library, and Scopus on June 2, 2024. We screened the retrieved studies for eligibility. Then extracted the data from the included studies, and then pooled the data as mean difference (MD) or odds ratio (OR) with a 95% confidence interval using Review Manager Software (ver. 3.5). Results: There was no significant difference between KA and MA in the different reported scores: combined KSS score at 6 months (P = 0.23) and 1 years (P = 0.60), KSS Patient satisfaction (P = 0.33), KSS function score (P = 0.07), Oxford score at 6 months (P = 0.45) and 2 years (P = 0.41), KOOS score (P = 0.26). Moreover, there was statistically significant difference in range of motion for flexion and extension at 1 and 2 years, incision length, the length of hospital stay, or the duration of surgery. Conclusion: Although kinematic alignment showed slightly better clinical outcomes than mechanical alignment, the difference between the two techniques is not statistically significant.
RESUMO
In total primary knee replacement surgery, the use of all-polyethylene tibial (APT) components has many advantages, including no backside wear and no linear dissociation. In addition, the greater polyethylene thickness permits more conservative bone resection compared with that for metal-backed components, with a lower unit cost and similar functional results. Thus, the use of an APT in primary total knee arthroplasty remains an attractive option. This is a review of 158 patients who underwent primary knee replacement using APT components from a single manufacturer. Data collection included age, American Society of Anesthesiology physical status classification, body mass index (BMI), type of deformity, the presence of diabetes mellitus, rate of revision, and characteristics associated with early failure of the components. Average follow-up time was 40 months. The revision rate for any reason was 5.6%, and the average BMI in revision cases was 37.6. Patients with a higher BMI (≥ 37.6) were significantly more likely to require revision surgery than patients with a lower BMI (p = 0.04). In our sample, high BMI was a contributing factor for early failures in total knee replacements using an APT component. Generally, polyethylene tibial components used for primary knee replacements are safe and effective, with good outcomes and subsequent lower costs to the health care system.
