Background

Numerous systematic reviews have been published comparing the outcomes of patients undergoing posterior stabilized (PS) versus cruciate-retaining (CR) procedures in total knee arthroplasty (TKA), but with some overlaps and contradictions. The objectives of this study were (1) to perform an overview of current systematic reviews comparing PS versus CR in TKA, by evaluating their methodological quality and risk of bias, and (2) to provide recommendations through the best evidence.

Methods

A systematic search of systematic reviews comparing PS and CR in TKA, published until June 2021 was conducted using the MEDLINE, EMBASE, and Cochrane Library databases. Included systematic reviews were assessed for methodological quality and risk of bias by the AMSTAR2 instrument and ROBIS tool, respectively. The choice of best evidence was conducted according to the Jadad decision algorithm.

Results

A total of eight systematic reviews were eligible for inclusion in this study. The Jadad decision algorithm suggested that reviews with the highest AMSTAR2 scores should be selected. According to the ROBIS tool, there were three reviews with a low risk of bias and five with a high risk of bias. Consequently, one systematic review conducted by Verra et al. with the highest AMSTAR2 score and low risk of bias was selected as the best evidence.

Conclusions

Although current systematic reviews demonstrated some statistical differences in clinical presentation and functional outcomes between PS and CR, the current outcome indicators cannot be taken to provide recommendations for undergoing PS or CR. The decision for prosthesis selection could be made mostly based on the surgeon’s preference, indications and other indicators.

中文翻译：

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全膝关节置换术中后稳定假体与十字形保留假体：系统评价和偏差考虑风险的概述

背景

已经发表了大量系统评价，比较了全膝关节置换术 (TKA) 中接受后稳定 (PS) 与十字形保留 (CR) 手术的患者的结果，但存在一些重叠和矛盾。本研究的目的是 (1) 通过评估其方法学质量和偏倚风险，对目前比较 TKA 中 PS 与 CR 的系统评价进行概述，以及 (2) 通过最佳证据提供建议。

方法

使用 MEDLINE、EMBASE 和 Cochrane 图书馆数据库对截至 2021 年 6 月发表的比较 TKA 中 PS 和 CR 的系统评价进行了系统检索。分别通过 AMSTAR2 仪器和 ROBIS 工具评估纳入的系统评价的方法学质量和偏倚风险。最佳证据的选择是根据Jadad决策算法进行的。

结果

共有八项系统评价符合纳入本研究的资格。Jadad 决策算法建议应选择 AMSTAR2 分数最高的评论。根据 ROBIS 工具，有 3 篇评论具有低偏倚风险，5 篇评论具有高偏倚风险。因此，Verra 等人进行了一项系统评价。选择具有最高 AMSTAR2 评分和低偏倚风险的证据作为最佳证据。

结论

尽管目前的系统评价表明 PS 和 CR 之间的临床表现和功能结果存在一些统计差异，但目前的结果指标不能为接受 PS 或 CR 提供建议。假体选择的决定主要取决于外科医生的偏好、适应症和其他指标。