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Meta-Analysis
. 2012 Oct 17;10(10):CD006193.
doi: 10.1002/14651858.CD006193.pub2.

Cemented, cementless or hybrid fixation options in total knee arthroplasty for osteoarthritis and other non-traumatic diseases

Gilberto Yoshinobu Nakama  1 , Maria Stella Peccin, Gustavo J M Almeida, Ozório de Almeida Lira Neto, Antônio A B Queiroz, Ricardo Dizioli Navarro
Affiliations
Meta-Analysis

Cemented, cementless or hybrid fixation options in total knee arthroplasty for osteoarthritis and other non-traumatic diseases

Gilberto Yoshinobu Nakama et al. Cochrane Database Syst Rev. .

Abstract

Background: It is not clear which fixation of total knee arthroplasty obtains the best clinical, functional and radiographic results in people with osteoarthritis and other non-traumatic diseases, such as rheumatoid arthritis.

Objectives: To assess the benefits and harms of cemented, cementless and hybrid knee prostheses fixation techniques in participants with primary osteoarthritis (osteoarthritis following trauma was not included) and other non-traumatic diseases, such as rheumatoid arthritis.

Search methods: We searched CENTRAL (2011, issue 10), MEDLINE via PubMed, EMBASE, Current Controlled Trials, LILACS, The Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Health Technology Assessment Database and the Database of Abstracts of Reviews of Effectiveness, all from implementation to October 2011, along with handsearches of high-yield journals and reference lists of articles. No language restrictions were applied.

Selection criteria: Randomized controlled trials (RCTs) evaluating cemented, cementless and hybrid fixation. Participants included patients that were 18 years or older with osteoarthritis and other non-traumatic diseases who were undergoing primary total knee arthroplasty.

Data collection and analysis: Three authors independently selected the eligible trials, assessed the trial quality, risk of bias and extracted data. Researchers were contacted to obtain missing information.

Main results: Five RCTs and 297 participants were included in this review. Using meta-analysis on roentgen stereophotogrammetric analysis (RSA) we observed that cemented fixation of the tibial components demonstrated smaller displacement in relation to cementless fixation (with and without hydroxyapatite) after a follow-up of two years (maximum total point-motion, N = 167, two RCTs, mean difference (MD) = 0.52 mm, 95% confidence interval (CI) 0.31 to 0.74). However, the risk of future aseptic loosening with uncemented fixation was approximately half that of cemented fixation according to the arthroplasty instability classification (moderate quality as assessed by GRADE) inferred from RSA (N = 216, three RCTs, risk ratio (RR) = 0.47, 95% CI 0.24 to 0.92) with a 16% absolute risk difference between groups. The number needed to treat for an additional beneficial outcome (NNTB) to prevent future aseptic loosening was 7 (95% CI 5 to 44). There was a low risk of bias for RSA among the studies included. It was not possible to perform meta-analysis on patient-important outcomes, such as the survival rate of the implant (any change of a component), patient global assessments, functional measures, pain, health-related quality of life measures and adverse events. Almost all included studies recorded functional measures of Knee Society and Hospital for Special Surgery knee scores, but the authors of each study found no significant difference between the groups.

Authors' conclusions: There was a smaller displacement of the cemented tibial component in relation to the cementless fixation in studies with osteoarthritis and rheumatoid arthritis participants who underwent primary total knee prosthesis with a follow-up of two years; however, the cemented fixation presented a greater risk of future aseptic loosening than cementless fixation.

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Conflict of interest statement

None known.

Ricardo Dizioli Navaro deceased; declarations of interest published in the protocol: "none known".

Figures

1
1
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3
Study flow diagram.
4
4
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
5
5
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Cemented versus uncemented with HA, Outcome 1 Absolute rotation about transverse axis in degrees (60 months).
1.2
1.2. Analysis
Comparison 1 Cemented versus uncemented with HA, Outcome 2 Absolute rotation about longitudinal axis in degrees (60 months).
1.3
1.3. Analysis
Comparison 1 Cemented versus uncemented with HA, Outcome 3 Absolute rotation about sagittal axis in degrees (60 months).
1.4
1.4. Analysis
Comparison 1 Cemented versus uncemented with HA, Outcome 4 Arthroplasty instability (arthroplasty instability was considered an event).
2.1
2.1. Analysis
Comparison 2 Cemented versus uncemented with and without HA, Outcome 1 Absolute rotation about transverse axis in degrees (60 months).
2.2
2.2. Analysis
Comparison 2 Cemented versus uncemented with and without HA, Outcome 2 Absolute rotation about longitudinal axis in degrees (60 months).
2.3
2.3. Analysis
Comparison 2 Cemented versus uncemented with and without HA, Outcome 3 Absolute rotation about sagittal axis in degrees (60 months).
2.4
2.4. Analysis
Comparison 2 Cemented versus uncemented with and without HA, Outcome 4 Maximum total point motion in millimeters (12 months).
2.5
2.5. Analysis
Comparison 2 Cemented versus uncemented with and without HA, Outcome 5 Maximum total point motion in millimeters (24 months).
2.6
2.6. Analysis
Comparison 2 Cemented versus uncemented with and without HA, Outcome 6 Arthroplasty instability (arthroplasty instability was considered an event).
3.1
3.1. Analysis
Comparison 3 Cemented versus uncemented without HA, Outcome 1 Maximum total point motion in millimeters (12 months).
3.2
3.2. Analysis
Comparison 3 Cemented versus uncemented without HA, Outcome 2 Maximum total point motion in millimeters (24 months).
3.3
3.3. Analysis
Comparison 3 Cemented versus uncemented without HA, Outcome 3 Arthroplasty instability (arthroplasty instability was considered an event).
See this image and copyright information in PMC

Update of

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