Cemented versus cementless Oxford unicompartmental knee arthroplasty for the treatment of medial knee osteoarthritis: an updated systematic review and meta-analysis

Abstract

Objective: This meta-analysis sought to compare the efficacy of cemented versus cementless Oxford unicompartmental knee arthroplasty(UKA) for the treatment of medial knee osteoarthritis.

Methods: A comprehensive search of the following databases was conducted: Pubmed, The Cochrane Library, China National Knowledge Infrastructure (CNKI), Embase, the Web of Science, and MEDLINE. The objective was to identify literature comparing cemented versus cementless Oxford unicompartmental knee arthroplasty for the treatment of medial knee osteoarthritis. Duplicate literature, low-quality literature, literature with incompatible observations, and literature for which the full text was not available were excluded. Two independent researchers employed the Cochrane Risk Assessment Tool and the Newcastle-Ottawa Scale (NOS) to evaluate the quality of the included literature. The data then were extracted and subsequently meta-analyzed using RevMan 5.4.

Results: A total of 12 papers were included in the analysis, encompassing a cumulative of 2558 cumulative cases. Of these, 1258 were cemented and 1300 were cementless. A meta-analysis was conducted to compare the outcomes of cemented versus cementless Oxford UKA. The Oxford UKA group exhibited a significantly longer surgery time than the cementless Oxford UKA group [mean difference (MD) = 9.91, 95% confidence interval (CI) (7.64,12.17)]. Additionally, the cemented Oxford UKA group demonstrated a significantly lower knee OKS score compared to the cementless Oxford UKA group. The mean difference (MD) was - 1.58 (95% CI: -2.30, -0.86), indicating a significantly lower score for the cemented Oxford UKA group. Similarly, the mean difference (MD) was - 1.8 for the knee KSS clinical score, indicating a significantly lower score for the cemented Oxford UKA group. The results demonstrated that the knee KSS functional score was significantly lower in the cemented Oxford UKA group than in the cementless Oxford UKA group [MD=-1.72, 95% CI (-3.26, -0.37)]. 95% CI (-3.27,-0.17)], the cemented Oxford UKA group exhibited a significantly higher incidence of radiolucent lines around the prosthesis than the cementless Oxford UKA group [ratio of ratios (OR) = 3.62, 95% CI (1.08,12.13)]. The revision rate was significantly higher in the cemented Oxford UKA group than in the cementless Oxford UKA group [OR = 2.22, 95% CI (1.40,3.53)]. However, no significant difference was observed between the two groups in terms of reoperation rate, five-year prosthesis survival rate, and complication rate.

Conclusions: The findings indicated that, in comparison to cemented Oxford UKA, cementless Oxford UKA resulted in a reduction in surgical time, an improvement in knee OKS score, KSS clinical score, and KSS functional score, and a decrease in the incidence of periprosthetic radiolucent lines and the rate of revisions.

Keywords: Cemented Oxford UKA; Cementless Oxford UKA; Medial knee osteoarthritis; Meta-analysis; Unicompartmental knee arthroplasty.