Abstract

Purpose

Modern TKR prostheses are designed to restore healthy kinematics including high flexion. Kneeling is a demanding high-flexion activity. There have been many studies of kneeling kinematics using a plethora of implant designs but no comprehensive comparisons. Visualisation of contact patterns allows for quantification and comparison of knee kinematics. The aim of this systematic review was to determine whether there are any differences in the kinematics of kneeling as a function of TKR design.

Methods

A search of the published literature identified 26 articles which were assessed for methodologic quality using the MINORS instrument. Contact patterns for different implant designs were compared at 90° and maximal flexion using quality-effects meta-analysis models.

Results

Twenty-five different implants using six designs were reported. Most of the included studies had small-sample sizes, were non-consecutive, and did not have a direct comparison group. Only posterior-stabilised fixed-bearing and cruciate-retaining fixed-bearing designs had data for more than 200 participants. Meta-analyses revealed that bicruciate-stabilised fixed-bearing designs appeared to achieve more flexion and the cruciate-retaining rotating-platform design achieved the least, but both included single studies only. All designs demonstrated posterior–femoral translation and external rotation in kneeling, but posterior-stabilised designs were more posterior at maximal flexion when compared to cruciate retaining. However, the heterogeneity of the mean estimates was substantial, and therefore, firm conclusions about relative behaviour cannot be drawn.

Conclusion

The high heterogeneity may be due to a combination of variability in the kneeling activity and variations in implant geometry within each design category. There remains a need for a high-quality prospective comparative studies to directly compare designs using a common method.

Level of evidence

Systematic review and meta-analysis Level IV

中文翻译：

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全膝关节置换术后下跪时组件设计对体内胫股接触方式的影响：系统评价和荟萃分析

摘要

目的

现代TKR假体旨在恢复健康的运动学，包括高屈曲性。跪姿是高屈曲活动。关于跪运动的研究已有很多，但都没有过多的比较。接触模式的可视化可以量化和比较膝关节运动学。本系统综述的目的是确定跪姿运动学是否与TKR设计有关。

方法

对已发表文献的搜索确定了26篇文章，这些文章使用MINORS仪器进行了方法学质量评估。使用质量效应荟萃分析模型，比较了不同植入物设计的接触模式在90°和最大屈曲度的情况。

结果

报告了使用六种设计的二十五个不同的植入物。纳入的大多数研究样本量小，不连续且没有直接比较组。仅后稳定固定支撑和十字形保持固定支撑设计具有200多个参与者的数据。荟萃分析显示，双十字稳定的固定轴承设计似乎可以实现更大的屈曲，而十字交叉固定的旋转平台设计获得的弯曲最少，但是两者都仅包括一项研究。所有设计均显示膝关节后股骨平移和外旋，但与十字形保持相比，后稳定设计在最大屈曲时更在后。但是，均值估算的异质性很大，因此，

结论

高异质性可能是由于跪姿活动的可变性和每种设计类别内植入物几何形状的变化共同造成的。仍然需要高质量的前瞻性比较研究，以使用通用方法直接比较设计。

证据水平

系统评价和荟萃分析IV级