膝关节骨性关节炎发病机制与临床治疗的相关研究
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摘要
背景:膝关节原发性骨性关节炎(KOA)是中老年人群的常见、多发病,发病机理尚不十分清楚,越来越多的学者认为其可能是一种多基因交互作用的复杂性疾病,也是一种慢性进行性炎症病变;白介素-16(IL-16)是炎性病变的主要细胞因子之一,目前对IL-16基因多态性与相关疾病的关联分析正成为许多学科的研究热点,但其与KOA的关联性研究尚未见报道。
目的:通过对IL-16等位基因多态性与中国广西汉族人群KOA的关联研究,探讨IL-16基因与KOA易感的关联性,依据实验结果提出可能的病因学假说。
方法:采用病例-对照研究设计,酚-氯仿抽提法提取全血白细胞,运用聚合酶链反应和限制性片段长度多态性等方法对年龄、性别匹配的100例KOA患者和100名健康对照受试者的IL-16等位基因的多态性进行单核苷酸多态性(SNP)位点筛查分析。
在NCBI-SNPs数据库查找IL-16基因的已知SNP位点-rs11556218T/G、rs4778889T/C、rs4072111C/T的单核苷酸多态性。计算基因型和等位基因频率,对检测数据分别行拟和优度X2检验基因型频率的分布,分析是否符合H-W平衡,对单个位点行基于基因型/等位基因频率的关联分析和基因型频率的Logistic回归分析,统计单个位点对KOA发病风险率的影响。用Haploview和在线软件SNPstats对3个位点连锁不平衡分析、单倍型关联分析,评估单倍型与KOA发生风险的相关性。
结果:共检测了IL-16基因的3个位点,有效样本两组各95例。病例组的性别构成(女/男)为71/24和对照组为62/33,两组间差异无统计学意义(x2=2.3, P=0.15);病例组的平均年龄60.52±9.92岁,对照组的平均年龄为58.28±10.36岁,两组间的年龄差异无统计学意义(t=1.52, P=0.07)。经拟合优度X2检验结果发现IL-16的三个SNP位点的P值均大于0.05,均符合Hardy-weinberg平衡。
利用在线的SNPstats对KOA组和正常对照组IL-16基因型各位点进行非条件Logistic回归模型分析,结果表明:
⑴rs11556218 T/G位点在Codominant模式中,相对于T/T,T/G为保护因素,OR值为0.40,95%CI为0.21-0.73,P值为0.0083;在Dominant模式中T/G-G/G相对于T/T为保护因素,OR值为0.46,95%CI为0.26~0.83,P值为0.0088;在Overdominat模式中,T/G相对于T/T-T/G为保护因素,OR值为0.40,95%CI为0.22~0.72,P值为0.002。
⑵rs4072111C/T位点在Codominant模式中,C/T相对于C/C是危险因素,OR值为1.98,95%CI为1.08~3.65,P值为0.036;在Overdominat模式中C/T相对于C/C-T/T是危险因素,OR值为2.08,95%CI为1.14~3.80,P值为0.016。
⑶rs4778889T/C位点在三种模式下均没有出现阳性结果。
⑷根据男女性别的不同基因型结果,在女性患者中,rs11556218T/G位点中,与TT型比较,T/G型是保护因素,OR为0.33,95% CI为0.16-0.70。在rs4072111C/T位点中,与CC型比较,C/T型是危险因素,OR为2.88,95% CI为1.37-6.04。而rs4778889T/C位点未能发现各基因型与男女性别之间存在统计学差异。
利用Haploview 4.0软件对IL-16基因内的三个不同位点之间进行连锁不平衡(LD)分析,结果发现2个位点之间有连锁不平衡关系,rs11556218T/G位点与rs4778889T/C位点之间存在一定的关联性。利用在线软件SNPStats分析单倍体的结果表明TTT型相对于TCT型是危险因素,OR值为2.42,95%CI为1.15~5.10,P值为0.021,GCC型相对于TCT型是保护因素,OR值为0.43, 95% CI为0.19~0.98,P值为0.045。
结论:基于95例KOA和95例健康对照的等位基因和基因型的单个位点关联分析的病例对照研究结果,我们认为,对中国汉族人群来说,IL-16等位基因的rs4072111C/T位点的基因多态性可能是KOA发生发展的危险因素,三位点构建的TTT单倍体型的遗传多态性也可能增加KOA易感风险。故IL-16基因的遗传变异可能是引起KOA发病的危险因素。
全膝关节置换术(TKA)是KOA等膝关节晚期病变的有效治疗措施,能有效矫正畸形、减轻疼痛、提高患肢功能,围手术期的并发症较少,是关节外科非常成熟的外科手术。
人工全膝关节假体分类按照假体设计所提供的限制程度可分为非限制性假体、部分限制性假体、高限制性假体和全限制性假体。部分限制性假体是临床上应用最广泛的全膝关节假体,包括多数的保留与不保留后交叉韧带假体、活动与固定平台膝关节假体系统以及高屈曲型假体。
随着社会发展,进行TKA人群的有年轻化的趋势,与手术疗效密切相关膝关节假体技术越来越多被人们所关注。而目前人工膝关节假体种类繁多,人们面对繁杂的膝关节假体常感困扰,如何合理选择膝关节假体是困扰临床工作者的难题之一,目前针对TKA中采用保留或不保留后交叉韧带假体、活动或固定平台膝关节假体以及高屈曲型假体或标准型假体等问题仍存在着较大的争议。
系统评价(SR)是一种非常严格的文献评价方法,它是针对某一个具体的临床课题,采用临床流行病学和医学统计学的理论和方法,全面系统收集全球所有的相关临床研究文献,筛选符合要求的研究文献,对数据进行定量合成分析或定性描述,可获得目前最佳的临床证据,进而指导临床实践或为今后的研究指明研究方向,这种方法能更少的减少各种误差和研究偏倚。
本研究的目的是通过系统评价的方法分别对TKA术中的假体的选择采用保留与不保留后交叉韧带假体、活动与固定平台膝关节假体、高屈曲性假体与标准型假体、全膝关节置换中选择保留和不保留髌骨的四个重要的争议进行循证研究。
(一)全膝置换中保留后交叉韧带与否的系统评价
目的:后交叉韧带对膝关节的稳定有非常重要的作用,学术界对TKA术中保留和不保留后交叉韧带仍有争议。本文的研究目的是通过系统评价TKA术中保留和不保留后交叉韧带随机对照试验,比较临床指标差异,以明确两种不同治疗措施的优劣。
方法:两研究者按照检索策略独立计算机检索Medline(1966年至2009年11月)、Embase(1980年至2009年11月)、Cochrane library(2009年第3期)、中国生物医学文献数据库(1990年至2009年11月)、中国医院期刊网全文数据库(1990年至2009年11月)、中国科技期刊全文数据库(1990年至2009年11月)、万方数据库(1990年至2009年11月)和相关的会议记录和相关文献的参考文献,手工检索5种中文骨科核心杂志收集比较保留和不保留后交叉韧带TKA术的随机对照试验,采用cochrance系统评价手册的随机对照试验方法学质量评价标准和随机对照试验流程评价研究的质量,提取数据分析并采用统计软件RevMan5.0.18进行Meta分析。
结果:经阅读标题、摘要和全文后,排除118篇文献,最后纳入12个随机对照试验,共1441膝,其中保留后交叉韧带组697膝,不保留后交叉韧带组744膝。依Cochrane的随机方法学评价标准,纳入研究的方法学质量均有不同的偏倚,依照CONSORT的22条评分标准结果:4个研究质量为优,4个为良,4个为中,指标分析结果是膝关节评分、功能评分、疼痛评分、本体觉和运动觉、关节并发症的发生率等指标的比较,组间差别均无统计学意义。关节活动度比较纳入7个研究,敏感性分析前组间差别有统计学意义(WMD=-3.25, 95%CI [-6.22, -0.28], P=0.03),剔除4个低质量的研究后组间差别没有显示统计学意义(WMD=-2.33, 95%CI[-5.06, -0.40], P=0.09)。
结论:早中期的随访结果显示保留和不保留后交叉韧带TKA的膝关节评分、功能评分、疼痛评分、本体觉和运动觉、关节并发症的发生率等指标的组间比较均无统计学意义,但敏感性分析后的3个质量较高研究的ROM的统计权重仍明显偏向非保留后交叉组,考虑非保留组的ROM有大于保留组的倾向。本研究部分文献的质量不高,样本数量偏小,建议开展更多高质量、大样本的临床随机对照试验以增加证据的强度。
(二)旋转和固定平台假体全膝置换疗效的系统评价
背景:旋转平台型假体和固定平台型假体各有优点,但学术界对两种平台假体在TKA术中的应用的疗效优劣仍有争议。过去十年全球开展了许多临床试验针对两类平台在TKA术中应用的疗效进行比较,仍未有明确的结论。
目的:通过系统评价的方法,比较TKA术中应用旋转平台型或固定平台型两种假体的临床结果,评价两组间的疗效差异。
方法:两研究者按照检索策略独立计算机检索Medline(1966年至2009年11月)、Embase(1980年至2009年11月)、Cochrane library(2009年第3期)、中国生物医学文献数据库(1990年至2009年11月)、中国期刊网全文数据库(1990年至2009年11月)、中国科技期刊全文数据库(1990年至2009年11月)、万方数据库(1990年至2009年11月)和相关的会议记录及相关文献的参考文献,手工检索5种中文骨科核心杂志收集比较旋转和固定型假体TKA疗效比较的随机对照试验,采用cochrance的方法学评价研究文献的质量,采用RevMan5.0.18进行Meta分析。
结果:经过阅读标题、摘要和全文后纳入11个随机对照试验,共1427膝,其中旋转型假体组694膝,固定型假体组723膝。依Cochrane的文献质量偏倚评价标准,纳入研究的方法学质量偏倚均较少,具有较好临床的同质性。两组术后均较术前有明显的疗效提高,但两组间比较,Meta分析的结果显示:术后膝关节评分、功能评分、疼痛评分、关节活动度以及假体脱位率、假体翻修率、膝关节假体周围的放射透光率、髌股关节Click症、髌斜率和前膝痛等不良事件的发生率均未能发现有明显的统计学差异。4例假体脱位的病例均发生在旋转组,脱位率约为1.8%(4/217)。
结论:目前证据表明以骨性关节炎为主的老年患者采用旋转平台型假体或固定平台型假体TKA在术后早中期的临床疗效和并发症发生率差异未发现明显的统计学和临床意义,无论选择何种假体均有可能获得满意的临床效果。但旋转平台假体有易脱位的趋势,需要开展更多高质量的研究加以证实。建议未来的研究比较两种假体的社会经济学方面差异,进行长期随访比较两者的磨损和翻修率,同时临床实践中重视康复锻炼。
目的:比较TKA中高屈曲型假体和标准型假体的不同术后关节活动度的测量结果,评价两类假体的疗效差异。
方法:检索Medline(1966~2010.01)、Embase(1980~2010.01)、Cochrane library(2010.01)、CBM(1990~2010.01)等数据库,收集比较高屈曲型假体和标准型假体TKA的随机对照试验,系统评价各研究并采用RevMan5.0.18进行Meta分析。
结果:纳入7个随机对照试验,8非随机的临床对照试验,但只有10个试验纳入Meta分析,包括1124膝,其中高屈曲型假体组551膝,标准型假体组573膝。对5个随机对照试验(RCT)与5个非随机的临床对照试验(CCT)进行亚组分析。统计结果显示CCT组:SD=2.82, 95%CI[0.28, 5.36], P=0.03;RCT组SD=1.77, 95%CI[0.01, 3.53], P=0.05。考虑非随机对照试验的研究偏倚较随机对照试验高,所以后者结果更可靠,故认为两者的术后关节活动度比较无明显差别。
结论:高屈曲型假体与标准型假体TKA的术后关节活动度比较无明显差别。高屈曲假体不能对所有的病例产生高屈曲关节活动度,假体不是术后关节活动度的唯一影响因素,TKA术中的假体选择应该综合考虑。
目的:探讨进行初次TKA中选择髌骨置换与否的疗效,评价两种不同治疗选择的差异。
方法:检索Medline、Embase、Cochrane library、CBM,收集行初次TKA中髌骨置换与否的临床对照试验,提取数据分析,采用RevMan5.0.18进行Meta分析。
结果:纳入8个前瞻性随机对照试验,共822例手术,其中髌骨置换组373例,髌骨非置换组444例。髌骨置换与非置换组比较,前膝痛与KSS评分均无明显的统计学意义(P>0.5),置换组的因髌股关节问题而再次手术率低于非置换组(RR=0.53, 95%CI [0.29, 0.96], P=0.04),但置换组再次手术的原因除了常见的前膝痛,还包括髌骨假体相关的并发症。
结论:的患者行初次TKA中选择髌骨置换与否的前膝痛与KSS评分无明显的统计学意义,置换组的因髌股关节问题再次手术率低于非置换组,但置换组再次手术的复杂性大于非置换组。
Background Knee osteoarthritis (KOA) is a common and frequently musculoskeletal disease among the elderly. However, the pathogenesis of this disorder is not fully understood, and more and more epidemiological studies have shown that KOA has a strong genetic component. IL-16 is one of the common cytokine of the chronic inflammatory diseases, and presently, its gene polymorphism has been discussed extensively. So the KOA, being regarded as one of the chronic inflammatory diseases, may be related with abnormal expression of IL-16 gene polymorphisms. However, the association between IL-16 gene ploymorphisms and KOA has not been reported.
Objective The aim of this study was to perform an association analysis of single-nucleotide polymorphisms (SNPs) in patients with radiographically defined osteoarthritis of the knee among the male Han people of the coastal area of Guangxi, China and identify the relationship between the gene polymorphisms and KOA. And to further explore possible etiologic hypothesis contributed to the onset of KOA based on the experimental results.
Methods A case-control study association study was conducted. A systematic screening for genetic variants in the complete IL-16 gene was performed, and the polymerase chain reaction and restriction fragment length polymorphism analysis were used to check 3 single nucleotide polymorphisms within IL-16 from 100 patients with KOA and 100 asymptomatic and radiographically negative control subjects matched exactly for age and sex of Chinese Han ancestry.
Genomic DNA from peripheral blood samples of each subjet was extracted by phenol-chloroform extraction. Based on NCBI gene-bank, the corresponding single nucleotide polymorphisms of IL-16 (rs11556218T/G, rs4778889T/C, and rs4072111C/T) were identified. Genotype and allele frequencies were calculated by SPSS and the Hardy-Weinberg equilibrium in the both groups were analyzed through Goodness-of-fit Chi-square test. The non-condition logistic regression analysis of single locus, based on analysis of the Genotype and allele frequencies, was performed to evaluate the association between onset risk of KOA and the single locus. Link disequilibrium analysis and haplotype association analysis were calculated using the SNPstats and software of Haploview 4.2 to evaluate the association between the haplotype and onset risk of KOA.
Results A total of 3 gene loci of IL-16 were tested. Only 95 out of 100 of DNA locis in each group were tested successfully, so the valid sample size within each group was 95. The female/male ratio among patients subject was 71/24, and the control subject was 62/33, and no significant differences were found between the two groups(x2=2.3, P=0.15); the mean age for the case group was 60.52±9.92 years and that for the control group was 58.28±10.36 years, with a t=1.52, P=0.07. Three gene loci of IL-16 both in case group and control groups were in Hardy-Weinberg equilibrium with a p-value>0.05 analyzed by Goodness-of-fit Chi-squ.
The results of non-conditional logistic regression model analysis, by SNPstats, on each gene loci of IL-16 both in case group and control groups showed that:⑴The rs11556218 in genotype association analysis in Codominant model, T/T was found to be a protective factor compared to T/G (OR=0.40, 95%CI=0.21-0.73, P=0.0083); T/G-G/G was found to be a protective factor compared to T/T in Dominant model (OR=0.46, 95%CI=0.26~0.83, P=0.0088); T/G was found to be a protective factor compared to T/T-T/G in Overdominat model (OR=0.40, 95%CI=0.22~0.72, P=0.002);⑵The 4072111 in genotype association analysis in Codominant model, C/T was found to be a risk factor compared to C/C (OR=1.98, 95%CI=1.08~3.65, P=0.036); C/T was found to be a a risk factor factor compared to C/C-T/T in Overdominat model (OR=2.08, 95%CI=1.14~3.80, P=0.016);⑶No positive result was found in association analysis in 3 statistical models for rs4778889.
According to different genotypes of male and female patients, in female patients, the rs11556218 in genotype association analysis, T/G was found to be a protective factor compared to TT (OR=0.33, 95%CI=0.16-0.70); the 4072111 in genotype association analysis, C/T was found to be a protective factor compared to CC (OR=2.88, 95%CI=1.37-6.04); No positive results were found in association analysis for rs4778889.
Linkage disequilibrium analysis was performed using the Haploview 4.2 software package for the 3 loci of IL-16, and the analysis found disequilibrium between loci rs11556218T/G and rs4778889T/C. The further stratification analysis by SNPstats based on phenotype showed that TTT was found to be a risk factor compared to TCT (OR=2.42, 95%CI=1.15~5.10, P=0.021), GCC was found to be a protective factor compared to TCT(OR=0.43, 95%CI=0.19~0.98, P=0.045).
Conclusions Based on this present case-control study included 95 KOA patients and 95 healthy controls, the results suggests that the IL-16 polymorphism rs4072111C/T is a risk factor for KOA susceptibility, and the TTT haplotype, derived from the allelic variant in the 3 genetic polymorphisms, may also be closely associated with the risk of knee osteoarthritis. So IL-16 allele is one of risk factors for the development of knee osteoarthritis in the Chinese Han population. The aims of primary total knee arthroplasty (TKA) are correction of deformity, relief of pain and improvement in function for knee osteoarthritis, great progress has been made on the study of TKA with both surgical techniques and prosthesis design in the past 40 years, and TKA has been widely used as effective treatments at present with few complications.
In accordance with the extent of mechanical restrictions, total knee prosthesis can be divided into non-prosthesis, semi-restraining knee prosthesis, high-constrained prosthesis and total-constrained prosthesis. Semi-restraining knee prosthesis is the most widely used in TKA and it included most of posterior cruciate retained or excised in TKA, mobile-bearing or fixed-bearing prosthesis and high-Flexion versus standard prostheses in TKA.
With the development of the society, there is a trend that the population of TKA is younger than before. The choice of proper knee prosthesis is closely related with the surgical treatment results and has been more and more attention. Knee prosthesis is abundant in variety, and people are often to be perplexed. How to choice the proper knee prosthesis is a hard nut for the clinical workers. Whether to choice the posterior cruciate retained or excised, mobile-bearing or fixed-bearing prosthesis and high-flexion or standard prostheses in total knee replacement are considerable controversies.
Systematic review is a rigorous evaluation method. It targets at a specific clinical topics by using the theoretical methods of clinical epidemiology and medical statistical methods, and by a careful screening of the research literatures that uses appropriate statistical techniques to combine these valid studies. It can reduce the likelihood of errors or bias, and is useful to show the direction for clinical practice or research.
The present study to investigate and evaluate according to the principle of evidence based medicine (EBM) and the purpose of it is to find whether prosthesis which cited above has superior outcomes in TKA.
Objective posterior cruciate ligament (PCL) is very important for the stability of knee joint, but whether PCL should be retained or excised in total knee arthroplasty is still in controversy. The aim of this study was to include all the randomized controlled trials (RCTs) with posterior cruciate retained versus excised in total knee arthroplasty and systematic review the research quality of each study, clinical efficacy was compared between two different therapeutic measures.
Methods Two researchers searched online independently according to the retrieval strategy. The RCTs with reference to Posterior cruciate retained versus excised in total knee arthroplasty were identified from Medline (1966-2009.11), Embase (1980-2009.11), Cochrane library (2009 issue 3), Chinese Biomedical Databases (1990 -2009.11), CNKI (1990-2009.11), VIP (1990-2009.11), and hand-searched several related journals, the study characteristics and the data on the participants, intervention, follow-up and outcome measures were extracted. The Methodology quality of each research was evaluated On the principles of Cochrance handbook 5.0.1, RevMan 5.0.18 software was used for meta-analysis.
Results After reading the title, abstract and fulltext, 118 articles were excluded. 12 RCTs were included which involving 1441 knees (697 knees in retained, 744 knees in excised). The results showed that the differeces between two groups had no statistical significance about knee score, function score, pain score, proprioception and kinesthesia, and the rate of joint complications. 7 studies were included when compared the ROM, the results of meta-analysis indicated that there was significant statistical difference between the 2 groups on the ROM before the sensitivity analysis (WMD=-3.25, 95%CI [-6.22, -0.28], P=0.03), but there was no statistical difference after 4 low quality studies were rejected (WMD=-2.33, 95%CI[-5.06, -0.40], P=0.09), but the forest plot of meta-analysis indicated the weight of ROM within 3 higher methodological studies bias to posterior cruciate excised in TKA.
Conclusion Short and median follow-up showed that no major differences on knee score, function score, pain score, proprioception, kinesthesia, and the rate of joint complications between posterior cruciate retained and excised in total knee arthroplasty, The ROM of the posterior cruciate excised may be higher than which of posterior cruciate retained within 5 years follow-up. In term of including some fair grade studies, we advised that more and stronger evidences should be needed for supporting the outcomes.
Background The differences between mobile-bearing and fixed-bearing in TKAs was still not clear. A few trials have compared the clinical performance of the two prostheses in the past ten years. The results of these studies are controversial.
Objective The purpose of this study was to compare the clinical results and possible complications of mobile bearing with fixed-bearing in total knee arthroplasty and assess the differences between the 2 groups.
Methods We conducted computer-aided searches of MEDLINE (January 1966 to November 2009), EMBASE (January 1980 to November 2009), Cochrane library (2009, Issue 3), Chinese Biomedical Databases (January 1990 to November 2009), CNKI (January 1990 to November 2009 ), VIP (January 1990 to November 2009) with reference to mobile bearing versus fixed-bearing in total knee arthroplasty, We also tracked references in bibliographies and hand-searched several related Chinese major journals, The methodological quality of included studies was assessed by the use of assessments of risk of bias in Cochrane handbook 5.0.1. Meta-analyses were performed using RevMan software, version 5.0.18.
Results 11 RCTs were included with a total of 1427 knees, 694 knees in the mobile bearing and 723 knees in fixed-bearing. Two review authors performed study selection, assessment of methodological quality and data extraction independently of each other. The bias in the studies were low and with well clinical homogeneity. The outcomes of Meta-analysis showed that there were no statistical significance on the Knee score, function score, pain score, range of motion (ROM), bearing dislocation, need for repeated surgery, Radiolucent line, knee clicking, patellar tilt and anterior knee pain. But 4 dislocation knees all occurred in four studies of mobile bearing TKA, the rate of dislocation is 1.8% (4/217).
Conclusion The results of short and median follow-up showed that there were no significant differences on clinical results and complications compared mobile bearing prosthesis with fixed-bearing prosthesis in total knee arthroplasty in the older population who mainly from osteoarthritis, and both bearing could have well clinical effects. But the mobile bearing prosthesis had a high risk of bearing dislocation, in term of including few studies, we advised that more evidences will be needed for supporting the outcomes.
Objective The aim of this study was to compare the range of motion (ROM) between high-flexion and standard prostheses in total knee arthroplasty.
Methods The databases of Cochrane library (2010, Issue 3), Medline (1966~2010.01), Embase (1980~2010.01) and Chinese Biomedical Databases (1990~2010.01) were searched online. All the trials comparing high-flexion with standard total knee prostheses for total knee replacement were included. Methodology quality of the trials was assessed and the data of the clinical outcomes within both groups was extracted. The Revman 5.0.18 was used for data-analysis.
Results In this study, we included eight controlled clinical trials (CCT), seven Randomized controlled trials (RCT), but only five RCTs and five CCTs with 1124 knees were included (551 High-Flexion/573 Standard) were included for meta-analysis, the result of Meta-analysis showed significant difference in ROM within two types in five CCTs (SD=4.39, 95%CI [2.56, 6.23], P=0.03), but no significant difference in five RCTs (SD=1.61, 95%CI [-0.26, 3.84], P=0.05). Considering the risk of bias in CCTs was higher than in RCTs, we regarded that the outcome of five RCTs was more reasonable.
Conclusion The ROM of the high-flexion prostheses in TKA did not higher than which of standard prostheses at least 1 year follow-up, Prosthesis selection in TKA should be overall considerate.
Objective The aim of this study was to compare the clinical effects between patellar resurfacing and non-resurfacing in total knee arthroplasty for osteoarthritis.
Methods The databases of Cochrane library, Medline, Embase and Chinese Biomedical Databases were searched online. All the trials comparing patellar resurfacing with non-resurfacing in total knee arthroplasty for osteoarthritis were included. Methodology quality was assessed and the data of the complications within both groups was extracted. The Revman 5.0.18 software package was used for data-analysis. The major causes of the reoperations in the patellar resurfacing group include anterior knee pain and the complications related to patellar component failure.
Results Eight trials with 822 knees were included (373 patellar resurfacing/ 444 patellar non-resurfacing). The meta-analysis showed that there were no differences in Knee Society Clinical Scores and anterior knee pain between the two groups with at least two year follow-up (P>0.5), but significant difference on reoperation for patellofemoral problems in favor of the nonresurfacing group (RR=0.53, P=0.04).
Conclusion Our results indicate that patellar resurfacing would reduce the risk of reoperation after total knee arthroplasty for osteoarthritis, but it seems that the benefits are limited on Knee Society Clinical Scores and anterior knee pain, and the reoperations in the patellar resurfacing group are usually more difficult than the nonresurfacing group.
目的:通过对IL-16等位基因多态性与中国广西汉族人群KOA的关联研究,探讨IL-16基因与KOA易感的关联性,依据实验结果提出可能的病因学假说。
方法:采用病例-对照研究设计,酚-氯仿抽提法提取全血白细胞,运用聚合酶链反应和限制性片段长度多态性等方法对年龄、性别匹配的100例KOA患者和100名健康对照受试者的IL-16等位基因的多态性进行单核苷酸多态性(SNP)位点筛查分析。
在NCBI-SNPs数据库查找IL-16基因的已知SNP位点-rs11556218T/G、rs4778889T/C、rs4072111C/T的单核苷酸多态性。计算基因型和等位基因频率,对检测数据分别行拟和优度X2检验基因型频率的分布,分析是否符合H-W平衡,对单个位点行基于基因型/等位基因频率的关联分析和基因型频率的Logistic回归分析,统计单个位点对KOA发病风险率的影响。用Haploview和在线软件SNPstats对3个位点连锁不平衡分析、单倍型关联分析,评估单倍型与KOA发生风险的相关性。
结果:共检测了IL-16基因的3个位点,有效样本两组各95例。病例组的性别构成(女/男)为71/24和对照组为62/33,两组间差异无统计学意义(x2=2.3, P=0.15);病例组的平均年龄60.52±9.92岁,对照组的平均年龄为58.28±10.36岁,两组间的年龄差异无统计学意义(t=1.52, P=0.07)。经拟合优度X2检验结果发现IL-16的三个SNP位点的P值均大于0.05,均符合Hardy-weinberg平衡。
利用在线的SNPstats对KOA组和正常对照组IL-16基因型各位点进行非条件Logistic回归模型分析,结果表明:
⑴rs11556218 T/G位点在Codominant模式中,相对于T/T,T/G为保护因素,OR值为0.40,95%CI为0.21-0.73,P值为0.0083;在Dominant模式中T/G-G/G相对于T/T为保护因素,OR值为0.46,95%CI为0.26~0.83,P值为0.0088;在Overdominat模式中,T/G相对于T/T-T/G为保护因素,OR值为0.40,95%CI为0.22~0.72,P值为0.002。
⑵rs4072111C/T位点在Codominant模式中,C/T相对于C/C是危险因素,OR值为1.98,95%CI为1.08~3.65,P值为0.036;在Overdominat模式中C/T相对于C/C-T/T是危险因素,OR值为2.08,95%CI为1.14~3.80,P值为0.016。
⑶rs4778889T/C位点在三种模式下均没有出现阳性结果。
⑷根据男女性别的不同基因型结果,在女性患者中,rs11556218T/G位点中,与TT型比较,T/G型是保护因素,OR为0.33,95% CI为0.16-0.70。在rs4072111C/T位点中,与CC型比较,C/T型是危险因素,OR为2.88,95% CI为1.37-6.04。而rs4778889T/C位点未能发现各基因型与男女性别之间存在统计学差异。
利用Haploview 4.0软件对IL-16基因内的三个不同位点之间进行连锁不平衡(LD)分析,结果发现2个位点之间有连锁不平衡关系,rs11556218T/G位点与rs4778889T/C位点之间存在一定的关联性。利用在线软件SNPStats分析单倍体的结果表明TTT型相对于TCT型是危险因素,OR值为2.42,95%CI为1.15~5.10,P值为0.021,GCC型相对于TCT型是保护因素,OR值为0.43, 95% CI为0.19~0.98,P值为0.045。
结论:基于95例KOA和95例健康对照的等位基因和基因型的单个位点关联分析的病例对照研究结果,我们认为,对中国汉族人群来说,IL-16等位基因的rs4072111C/T位点的基因多态性可能是KOA发生发展的危险因素,三位点构建的TTT单倍体型的遗传多态性也可能增加KOA易感风险。故IL-16基因的遗传变异可能是引起KOA发病的危险因素。
全膝关节置换术(TKA)是KOA等膝关节晚期病变的有效治疗措施,能有效矫正畸形、减轻疼痛、提高患肢功能,围手术期的并发症较少,是关节外科非常成熟的外科手术。
人工全膝关节假体分类按照假体设计所提供的限制程度可分为非限制性假体、部分限制性假体、高限制性假体和全限制性假体。部分限制性假体是临床上应用最广泛的全膝关节假体,包括多数的保留与不保留后交叉韧带假体、活动与固定平台膝关节假体系统以及高屈曲型假体。
随着社会发展,进行TKA人群的有年轻化的趋势,与手术疗效密切相关膝关节假体技术越来越多被人们所关注。而目前人工膝关节假体种类繁多,人们面对繁杂的膝关节假体常感困扰,如何合理选择膝关节假体是困扰临床工作者的难题之一,目前针对TKA中采用保留或不保留后交叉韧带假体、活动或固定平台膝关节假体以及高屈曲型假体或标准型假体等问题仍存在着较大的争议。
系统评价(SR)是一种非常严格的文献评价方法,它是针对某一个具体的临床课题,采用临床流行病学和医学统计学的理论和方法,全面系统收集全球所有的相关临床研究文献,筛选符合要求的研究文献,对数据进行定量合成分析或定性描述,可获得目前最佳的临床证据,进而指导临床实践或为今后的研究指明研究方向,这种方法能更少的减少各种误差和研究偏倚。
本研究的目的是通过系统评价的方法分别对TKA术中的假体的选择采用保留与不保留后交叉韧带假体、活动与固定平台膝关节假体、高屈曲性假体与标准型假体、全膝关节置换中选择保留和不保留髌骨的四个重要的争议进行循证研究。
(一)全膝置换中保留后交叉韧带与否的系统评价
目的:后交叉韧带对膝关节的稳定有非常重要的作用,学术界对TKA术中保留和不保留后交叉韧带仍有争议。本文的研究目的是通过系统评价TKA术中保留和不保留后交叉韧带随机对照试验,比较临床指标差异,以明确两种不同治疗措施的优劣。
方法:两研究者按照检索策略独立计算机检索Medline(1966年至2009年11月)、Embase(1980年至2009年11月)、Cochrane library(2009年第3期)、中国生物医学文献数据库(1990年至2009年11月)、中国医院期刊网全文数据库(1990年至2009年11月)、中国科技期刊全文数据库(1990年至2009年11月)、万方数据库(1990年至2009年11月)和相关的会议记录和相关文献的参考文献,手工检索5种中文骨科核心杂志收集比较保留和不保留后交叉韧带TKA术的随机对照试验,采用cochrance系统评价手册的随机对照试验方法学质量评价标准和随机对照试验流程评价研究的质量,提取数据分析并采用统计软件RevMan5.0.18进行Meta分析。
结果:经阅读标题、摘要和全文后,排除118篇文献,最后纳入12个随机对照试验,共1441膝,其中保留后交叉韧带组697膝,不保留后交叉韧带组744膝。依Cochrane的随机方法学评价标准,纳入研究的方法学质量均有不同的偏倚,依照CONSORT的22条评分标准结果:4个研究质量为优,4个为良,4个为中,指标分析结果是膝关节评分、功能评分、疼痛评分、本体觉和运动觉、关节并发症的发生率等指标的比较,组间差别均无统计学意义。关节活动度比较纳入7个研究,敏感性分析前组间差别有统计学意义(WMD=-3.25, 95%CI [-6.22, -0.28], P=0.03),剔除4个低质量的研究后组间差别没有显示统计学意义(WMD=-2.33, 95%CI[-5.06, -0.40], P=0.09)。
结论:早中期的随访结果显示保留和不保留后交叉韧带TKA的膝关节评分、功能评分、疼痛评分、本体觉和运动觉、关节并发症的发生率等指标的组间比较均无统计学意义,但敏感性分析后的3个质量较高研究的ROM的统计权重仍明显偏向非保留后交叉组,考虑非保留组的ROM有大于保留组的倾向。本研究部分文献的质量不高,样本数量偏小,建议开展更多高质量、大样本的临床随机对照试验以增加证据的强度。
(二)旋转和固定平台假体全膝置换疗效的系统评价
背景:旋转平台型假体和固定平台型假体各有优点,但学术界对两种平台假体在TKA术中的应用的疗效优劣仍有争议。过去十年全球开展了许多临床试验针对两类平台在TKA术中应用的疗效进行比较,仍未有明确的结论。
目的:通过系统评价的方法,比较TKA术中应用旋转平台型或固定平台型两种假体的临床结果,评价两组间的疗效差异。
方法:两研究者按照检索策略独立计算机检索Medline(1966年至2009年11月)、Embase(1980年至2009年11月)、Cochrane library(2009年第3期)、中国生物医学文献数据库(1990年至2009年11月)、中国期刊网全文数据库(1990年至2009年11月)、中国科技期刊全文数据库(1990年至2009年11月)、万方数据库(1990年至2009年11月)和相关的会议记录及相关文献的参考文献,手工检索5种中文骨科核心杂志收集比较旋转和固定型假体TKA疗效比较的随机对照试验,采用cochrance的方法学评价研究文献的质量,采用RevMan5.0.18进行Meta分析。
结果:经过阅读标题、摘要和全文后纳入11个随机对照试验,共1427膝,其中旋转型假体组694膝,固定型假体组723膝。依Cochrane的文献质量偏倚评价标准,纳入研究的方法学质量偏倚均较少,具有较好临床的同质性。两组术后均较术前有明显的疗效提高,但两组间比较,Meta分析的结果显示:术后膝关节评分、功能评分、疼痛评分、关节活动度以及假体脱位率、假体翻修率、膝关节假体周围的放射透光率、髌股关节Click症、髌斜率和前膝痛等不良事件的发生率均未能发现有明显的统计学差异。4例假体脱位的病例均发生在旋转组,脱位率约为1.8%(4/217)。
结论:目前证据表明以骨性关节炎为主的老年患者采用旋转平台型假体或固定平台型假体TKA在术后早中期的临床疗效和并发症发生率差异未发现明显的统计学和临床意义,无论选择何种假体均有可能获得满意的临床效果。但旋转平台假体有易脱位的趋势,需要开展更多高质量的研究加以证实。建议未来的研究比较两种假体的社会经济学方面差异,进行长期随访比较两者的磨损和翻修率,同时临床实践中重视康复锻炼。
目的:比较TKA中高屈曲型假体和标准型假体的不同术后关节活动度的测量结果,评价两类假体的疗效差异。
方法:检索Medline(1966~2010.01)、Embase(1980~2010.01)、Cochrane library(2010.01)、CBM(1990~2010.01)等数据库,收集比较高屈曲型假体和标准型假体TKA的随机对照试验,系统评价各研究并采用RevMan5.0.18进行Meta分析。
结果:纳入7个随机对照试验,8非随机的临床对照试验,但只有10个试验纳入Meta分析,包括1124膝,其中高屈曲型假体组551膝,标准型假体组573膝。对5个随机对照试验(RCT)与5个非随机的临床对照试验(CCT)进行亚组分析。统计结果显示CCT组:SD=2.82, 95%CI[0.28, 5.36], P=0.03;RCT组SD=1.77, 95%CI[0.01, 3.53], P=0.05。考虑非随机对照试验的研究偏倚较随机对照试验高,所以后者结果更可靠,故认为两者的术后关节活动度比较无明显差别。
结论:高屈曲型假体与标准型假体TKA的术后关节活动度比较无明显差别。高屈曲假体不能对所有的病例产生高屈曲关节活动度,假体不是术后关节活动度的唯一影响因素,TKA术中的假体选择应该综合考虑。
目的:探讨进行初次TKA中选择髌骨置换与否的疗效,评价两种不同治疗选择的差异。
方法:检索Medline、Embase、Cochrane library、CBM,收集行初次TKA中髌骨置换与否的临床对照试验,提取数据分析,采用RevMan5.0.18进行Meta分析。
结果:纳入8个前瞻性随机对照试验,共822例手术,其中髌骨置换组373例,髌骨非置换组444例。髌骨置换与非置换组比较,前膝痛与KSS评分均无明显的统计学意义(P>0.5),置换组的因髌股关节问题而再次手术率低于非置换组(RR=0.53, 95%CI [0.29, 0.96], P=0.04),但置换组再次手术的原因除了常见的前膝痛,还包括髌骨假体相关的并发症。
结论:的患者行初次TKA中选择髌骨置换与否的前膝痛与KSS评分无明显的统计学意义,置换组的因髌股关节问题再次手术率低于非置换组,但置换组再次手术的复杂性大于非置换组。
Background Knee osteoarthritis (KOA) is a common and frequently musculoskeletal disease among the elderly. However, the pathogenesis of this disorder is not fully understood, and more and more epidemiological studies have shown that KOA has a strong genetic component. IL-16 is one of the common cytokine of the chronic inflammatory diseases, and presently, its gene polymorphism has been discussed extensively. So the KOA, being regarded as one of the chronic inflammatory diseases, may be related with abnormal expression of IL-16 gene polymorphisms. However, the association between IL-16 gene ploymorphisms and KOA has not been reported.
Objective The aim of this study was to perform an association analysis of single-nucleotide polymorphisms (SNPs) in patients with radiographically defined osteoarthritis of the knee among the male Han people of the coastal area of Guangxi, China and identify the relationship between the gene polymorphisms and KOA. And to further explore possible etiologic hypothesis contributed to the onset of KOA based on the experimental results.
Methods A case-control study association study was conducted. A systematic screening for genetic variants in the complete IL-16 gene was performed, and the polymerase chain reaction and restriction fragment length polymorphism analysis were used to check 3 single nucleotide polymorphisms within IL-16 from 100 patients with KOA and 100 asymptomatic and radiographically negative control subjects matched exactly for age and sex of Chinese Han ancestry.
Genomic DNA from peripheral blood samples of each subjet was extracted by phenol-chloroform extraction. Based on NCBI gene-bank, the corresponding single nucleotide polymorphisms of IL-16 (rs11556218T/G, rs4778889T/C, and rs4072111C/T) were identified. Genotype and allele frequencies were calculated by SPSS and the Hardy-Weinberg equilibrium in the both groups were analyzed through Goodness-of-fit Chi-square test. The non-condition logistic regression analysis of single locus, based on analysis of the Genotype and allele frequencies, was performed to evaluate the association between onset risk of KOA and the single locus. Link disequilibrium analysis and haplotype association analysis were calculated using the SNPstats and software of Haploview 4.2 to evaluate the association between the haplotype and onset risk of KOA.
Results A total of 3 gene loci of IL-16 were tested. Only 95 out of 100 of DNA locis in each group were tested successfully, so the valid sample size within each group was 95. The female/male ratio among patients subject was 71/24, and the control subject was 62/33, and no significant differences were found between the two groups(x2=2.3, P=0.15); the mean age for the case group was 60.52±9.92 years and that for the control group was 58.28±10.36 years, with a t=1.52, P=0.07. Three gene loci of IL-16 both in case group and control groups were in Hardy-Weinberg equilibrium with a p-value>0.05 analyzed by Goodness-of-fit Chi-squ.
The results of non-conditional logistic regression model analysis, by SNPstats, on each gene loci of IL-16 both in case group and control groups showed that:⑴The rs11556218 in genotype association analysis in Codominant model, T/T was found to be a protective factor compared to T/G (OR=0.40, 95%CI=0.21-0.73, P=0.0083); T/G-G/G was found to be a protective factor compared to T/T in Dominant model (OR=0.46, 95%CI=0.26~0.83, P=0.0088); T/G was found to be a protective factor compared to T/T-T/G in Overdominat model (OR=0.40, 95%CI=0.22~0.72, P=0.002);⑵The 4072111 in genotype association analysis in Codominant model, C/T was found to be a risk factor compared to C/C (OR=1.98, 95%CI=1.08~3.65, P=0.036); C/T was found to be a a risk factor factor compared to C/C-T/T in Overdominat model (OR=2.08, 95%CI=1.14~3.80, P=0.016);⑶No positive result was found in association analysis in 3 statistical models for rs4778889.
According to different genotypes of male and female patients, in female patients, the rs11556218 in genotype association analysis, T/G was found to be a protective factor compared to TT (OR=0.33, 95%CI=0.16-0.70); the 4072111 in genotype association analysis, C/T was found to be a protective factor compared to CC (OR=2.88, 95%CI=1.37-6.04); No positive results were found in association analysis for rs4778889.
Linkage disequilibrium analysis was performed using the Haploview 4.2 software package for the 3 loci of IL-16, and the analysis found disequilibrium between loci rs11556218T/G and rs4778889T/C. The further stratification analysis by SNPstats based on phenotype showed that TTT was found to be a risk factor compared to TCT (OR=2.42, 95%CI=1.15~5.10, P=0.021), GCC was found to be a protective factor compared to TCT(OR=0.43, 95%CI=0.19~0.98, P=0.045).
Conclusions Based on this present case-control study included 95 KOA patients and 95 healthy controls, the results suggests that the IL-16 polymorphism rs4072111C/T is a risk factor for KOA susceptibility, and the TTT haplotype, derived from the allelic variant in the 3 genetic polymorphisms, may also be closely associated with the risk of knee osteoarthritis. So IL-16 allele is one of risk factors for the development of knee osteoarthritis in the Chinese Han population. The aims of primary total knee arthroplasty (TKA) are correction of deformity, relief of pain and improvement in function for knee osteoarthritis, great progress has been made on the study of TKA with both surgical techniques and prosthesis design in the past 40 years, and TKA has been widely used as effective treatments at present with few complications.
In accordance with the extent of mechanical restrictions, total knee prosthesis can be divided into non-prosthesis, semi-restraining knee prosthesis, high-constrained prosthesis and total-constrained prosthesis. Semi-restraining knee prosthesis is the most widely used in TKA and it included most of posterior cruciate retained or excised in TKA, mobile-bearing or fixed-bearing prosthesis and high-Flexion versus standard prostheses in TKA.
With the development of the society, there is a trend that the population of TKA is younger than before. The choice of proper knee prosthesis is closely related with the surgical treatment results and has been more and more attention. Knee prosthesis is abundant in variety, and people are often to be perplexed. How to choice the proper knee prosthesis is a hard nut for the clinical workers. Whether to choice the posterior cruciate retained or excised, mobile-bearing or fixed-bearing prosthesis and high-flexion or standard prostheses in total knee replacement are considerable controversies.
Systematic review is a rigorous evaluation method. It targets at a specific clinical topics by using the theoretical methods of clinical epidemiology and medical statistical methods, and by a careful screening of the research literatures that uses appropriate statistical techniques to combine these valid studies. It can reduce the likelihood of errors or bias, and is useful to show the direction for clinical practice or research.
The present study to investigate and evaluate according to the principle of evidence based medicine (EBM) and the purpose of it is to find whether prosthesis which cited above has superior outcomes in TKA.
Objective posterior cruciate ligament (PCL) is very important for the stability of knee joint, but whether PCL should be retained or excised in total knee arthroplasty is still in controversy. The aim of this study was to include all the randomized controlled trials (RCTs) with posterior cruciate retained versus excised in total knee arthroplasty and systematic review the research quality of each study, clinical efficacy was compared between two different therapeutic measures.
Methods Two researchers searched online independently according to the retrieval strategy. The RCTs with reference to Posterior cruciate retained versus excised in total knee arthroplasty were identified from Medline (1966-2009.11), Embase (1980-2009.11), Cochrane library (2009 issue 3), Chinese Biomedical Databases (1990 -2009.11), CNKI (1990-2009.11), VIP (1990-2009.11), and hand-searched several related journals, the study characteristics and the data on the participants, intervention, follow-up and outcome measures were extracted. The Methodology quality of each research was evaluated On the principles of Cochrance handbook 5.0.1, RevMan 5.0.18 software was used for meta-analysis.
Results After reading the title, abstract and fulltext, 118 articles were excluded. 12 RCTs were included which involving 1441 knees (697 knees in retained, 744 knees in excised). The results showed that the differeces between two groups had no statistical significance about knee score, function score, pain score, proprioception and kinesthesia, and the rate of joint complications. 7 studies were included when compared the ROM, the results of meta-analysis indicated that there was significant statistical difference between the 2 groups on the ROM before the sensitivity analysis (WMD=-3.25, 95%CI [-6.22, -0.28], P=0.03), but there was no statistical difference after 4 low quality studies were rejected (WMD=-2.33, 95%CI[-5.06, -0.40], P=0.09), but the forest plot of meta-analysis indicated the weight of ROM within 3 higher methodological studies bias to posterior cruciate excised in TKA.
Conclusion Short and median follow-up showed that no major differences on knee score, function score, pain score, proprioception, kinesthesia, and the rate of joint complications between posterior cruciate retained and excised in total knee arthroplasty, The ROM of the posterior cruciate excised may be higher than which of posterior cruciate retained within 5 years follow-up. In term of including some fair grade studies, we advised that more and stronger evidences should be needed for supporting the outcomes.
Background The differences between mobile-bearing and fixed-bearing in TKAs was still not clear. A few trials have compared the clinical performance of the two prostheses in the past ten years. The results of these studies are controversial.
Objective The purpose of this study was to compare the clinical results and possible complications of mobile bearing with fixed-bearing in total knee arthroplasty and assess the differences between the 2 groups.
Methods We conducted computer-aided searches of MEDLINE (January 1966 to November 2009), EMBASE (January 1980 to November 2009), Cochrane library (2009, Issue 3), Chinese Biomedical Databases (January 1990 to November 2009), CNKI (January 1990 to November 2009 ), VIP (January 1990 to November 2009) with reference to mobile bearing versus fixed-bearing in total knee arthroplasty, We also tracked references in bibliographies and hand-searched several related Chinese major journals, The methodological quality of included studies was assessed by the use of assessments of risk of bias in Cochrane handbook 5.0.1. Meta-analyses were performed using RevMan software, version 5.0.18.
Results 11 RCTs were included with a total of 1427 knees, 694 knees in the mobile bearing and 723 knees in fixed-bearing. Two review authors performed study selection, assessment of methodological quality and data extraction independently of each other. The bias in the studies were low and with well clinical homogeneity. The outcomes of Meta-analysis showed that there were no statistical significance on the Knee score, function score, pain score, range of motion (ROM), bearing dislocation, need for repeated surgery, Radiolucent line, knee clicking, patellar tilt and anterior knee pain. But 4 dislocation knees all occurred in four studies of mobile bearing TKA, the rate of dislocation is 1.8% (4/217).
Conclusion The results of short and median follow-up showed that there were no significant differences on clinical results and complications compared mobile bearing prosthesis with fixed-bearing prosthesis in total knee arthroplasty in the older population who mainly from osteoarthritis, and both bearing could have well clinical effects. But the mobile bearing prosthesis had a high risk of bearing dislocation, in term of including few studies, we advised that more evidences will be needed for supporting the outcomes.
Objective The aim of this study was to compare the range of motion (ROM) between high-flexion and standard prostheses in total knee arthroplasty.
Methods The databases of Cochrane library (2010, Issue 3), Medline (1966~2010.01), Embase (1980~2010.01) and Chinese Biomedical Databases (1990~2010.01) were searched online. All the trials comparing high-flexion with standard total knee prostheses for total knee replacement were included. Methodology quality of the trials was assessed and the data of the clinical outcomes within both groups was extracted. The Revman 5.0.18 was used for data-analysis.
Results In this study, we included eight controlled clinical trials (CCT), seven Randomized controlled trials (RCT), but only five RCTs and five CCTs with 1124 knees were included (551 High-Flexion/573 Standard) were included for meta-analysis, the result of Meta-analysis showed significant difference in ROM within two types in five CCTs (SD=4.39, 95%CI [2.56, 6.23], P=0.03), but no significant difference in five RCTs (SD=1.61, 95%CI [-0.26, 3.84], P=0.05). Considering the risk of bias in CCTs was higher than in RCTs, we regarded that the outcome of five RCTs was more reasonable.
Conclusion The ROM of the high-flexion prostheses in TKA did not higher than which of standard prostheses at least 1 year follow-up, Prosthesis selection in TKA should be overall considerate.
Objective The aim of this study was to compare the clinical effects between patellar resurfacing and non-resurfacing in total knee arthroplasty for osteoarthritis.
Methods The databases of Cochrane library, Medline, Embase and Chinese Biomedical Databases were searched online. All the trials comparing patellar resurfacing with non-resurfacing in total knee arthroplasty for osteoarthritis were included. Methodology quality was assessed and the data of the complications within both groups was extracted. The Revman 5.0.18 software package was used for data-analysis. The major causes of the reoperations in the patellar resurfacing group include anterior knee pain and the complications related to patellar component failure.
Results Eight trials with 822 knees were included (373 patellar resurfacing/ 444 patellar non-resurfacing). The meta-analysis showed that there were no differences in Knee Society Clinical Scores and anterior knee pain between the two groups with at least two year follow-up (P>0.5), but significant difference on reoperation for patellofemoral problems in favor of the nonresurfacing group (RR=0.53, P=0.04).
Conclusion Our results indicate that patellar resurfacing would reduce the risk of reoperation after total knee arthroplasty for osteoarthritis, but it seems that the benefits are limited on Knee Society Clinical Scores and anterior knee pain, and the reoperations in the patellar resurfacing group are usually more difficult than the nonresurfacing group.
引文
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