The Clinical Outcomes of Measured Resection and Gap Balancing Techniques in Primary Total Knee Arthroplasty: A Meta-analysis

Abstract

Background At present, the clinical efficacy of measured resection (MR) and gap balancing (GB) techniques in total knee arthroplasty (TKA) is still controversial. The objective of this study was to evaluate the clinical outcome indexes of the two surgical methods through a meta-analysis.

Methods The literature was systematically searched on PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), WANFANG, Weipu (VIP), and China Biomedical Literature (CBM) electronic databases inception until June 12, 2022. RevMan 5.3 software (the Nordic Cochrane Center, the Cochrane Collaboration, Copenhagen, Denmark) was used to analyze all data of this study. The Cochrane risk bias assessment tool is a risk bias evaluation criterion recommended by the Cochrane Handbook for systematic reviews.

Results Eleven studies involving 1268 knees in total were included. The main outcome indexes showed that the Knee Society Score (KSS) knee score (MD: −1.40; 95% CI: −2.57 to −0.22; p = 0.02) and KSS knee function score (MD: −3.11; 95% CI: −3.72 to −2.50; p < 0.001) in the GB group were higher 1 year after operation, while femoral component rotation angle (FCRA; MD: −0.75; 95% CI: −1.34 to −0.07; p = 0.03) and the osteotomy volume of the posterior medial femoral condyle (MD: −0.76; 95% CI; −1.13 to −0.38; p < 0.001) were greater in the GB group. In addition, there was no significant difference in the joint line change (MD: −0.03; 95% CI: −0.07 to 0.01; p = 0.16) between the two groups. Secondary outcome results showed that the knee joint range of motion (ROM) in 3 months, and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score after 1 year were better in the GB group. However, the operation time of the MR group was shorter. In addition, this study revealed no significant differences in post-complications between these two groups.

Conclusion Although the GB technique may not provide better radiographic results or reduce the complication rate, the recovery of joint function showed earlier improvement.

Zusammenfassung

Hintergrund Derzeit ist die klinische Wirksamkeit von gemessenen Resektions- (MR) und Gap-Balancing-Techniken (GB) in der totalen Kniearthroplastik (TKA) noch umstritten.

Ziel Diese Studie wird die klinischen Ergebnisindizes der beiden chirurgischen Methoden durch eine Metaanalyse bewerten.

Methoden Bis zum 12. Juni 2022 wurden systematische Literaturrecherchen aus elektronischen Datenbanken durchgeführt, darunter PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), WANFANG, Weipu (VIP) und China Biomedical Literature (CBM). Die RevMan 5.3 Software wurde verwendet, um alle Daten dieser Studie zu analysieren. Zur Beurteilung der Literaturqualität wurde das Cochrane Risk Bias Assessment Tool verwendet.

Ergebnisse Es wurden 11 Studien mit insgesamt 1268 Knien eingeschlossen. Die wichtigsten Ergebnisindizes zeigten, dass der Knee Society Score (KSS; MD: −1,40; 95%-KI: −2,57 bis −0,22; P = 0,02) und der KSS-Kniefunktions-Score (MD: −3,11; 95%-KI: −3,72 bis −2,50; P < 0,001) in der GB-Gruppe 1 Jahr nach der Operation höher waren. Der Rotationswinkel der femoralen Komponente (FCRA; MD: −0,75; 95%-KI: −1,34 bis −0,07; P = 0,03) und das Osteotomievolumen des hinteren medialen Femurkondylus (MD: −0,76; 95%-KI: −1,13 bis −0,38; P < 0,001) waren in der GB-Gruppe größer. Darüber hinaus gab es keinen signifikanten Unterschied in der Änderung der Gelenklinie (MD: −0,03; 95%-KI: −0,07 bis 0,01; P = 0,16) zwischen den beiden Gruppen. Sekundäre Endpunkte zeigten, dass der Bewegungsumfang des Kniegelenks (ROM) in 3 Monaten und der Western Ontario and McMaster University Osteoarthritis Index (WOMAC) in 1 Jahr in der GB-Gruppe besser waren. Allerdings war die Operationszeit der MR-Gruppe kürzer. Darüber hinaus hat diese Studie keine signifikanten Unterschiede in den Postkomplikationen zwischen diesen beiden Techniken gezeigt.

Schlussfolgerung Obwohl die Gap-Balancing-Technik möglicherweise keine besseren Röntgenergebnisse liefert oder die Komplikationsrate reduziert, war die Wiederherstellung der Gelenkfunktion frühzeitig besser.

Keywords

gap balancing technique - measured resection technique - knee - total knee arthroplasty - meta-analysis - clinical outcomes

Schlüsselwörter

Spaltausgleichsverfahren - messbare Resektionstechnik - Knie - Metaanalyse - klinische Ergebnisse

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