Comparison of the accuracy and efficacy of different assistive techniques in primary total knee arthroplasty: A network meta‐analysis
Abstract Purpose Various assistive techniques, such as conventional cutting instruments (CON), computer‐assisted navigation systems (CAS), patient‐specific instruments (PSI) and robot‐assisted systems (RAS), have been developed and applied in primary total knee arthroplasty (TKA). In this study, we...
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2024-10-01
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| Series: | Journal of Experimental Orthopaedics |
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| Online Access: | https://doi.org/10.1002/jeo2.70098 |
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| author | Yuhang Zheng Yang Li Ziqi Yuan Xiao Geng Hua Tian |
| author_facet | Yuhang Zheng Yang Li Ziqi Yuan Xiao Geng Hua Tian |
| author_sort | Yuhang Zheng |
| collection | DOAJ |
| description | Abstract Purpose Various assistive techniques, such as conventional cutting instruments (CON), computer‐assisted navigation systems (CAS), patient‐specific instruments (PSI) and robot‐assisted systems (RAS), have been developed and applied in primary total knee arthroplasty (TKA). In this study, we aimed to assess the relative accuracy and efficacy of several assistive techniques for TKA through a network meta‐analysis (NMA) based on multiple published randomized controlled trials (RCTs). Methods The PubMed, EMBASE and Cochrane databases were searched for RCTs to conduct this NMA from inception to 1 January 2024. We combined direct and indirect comparisons using a Bayesian NMA framework to assess and compare the effects of different assistive techniques on radiological and clinical outcomes. An NMA was conducted, and the study protocol was published online at PROSPERO (CRD42023402882). Results One hundred and twelve RCTs involving 14,968 TKAs with four different assistive techniques (CON, CAS, PSI and RAS) were evaluated. Inconsistency and heterogeneity were acceptable for most outcomes. Based on the surface under the cumulative ranking curve, RAS could be the best technique for accurate mechanical axis alignment and component position, followed by CAS, PSI and CON. We observed no difference in clinical outcome scores. Additionally, CAS was the best intervention for visual analogue scale scores, and PSI had the shortest operative time. No significant differences were observed in postoperative complications, range of motion or total blood loss. Conclusion RAS was most likely to achieve an accurate alignment, followed by CAS, PSI and CON. No differences were observed in clinical outcome scores and postoperative complications among the four assistive techniques. Level of Evidence Level I (systematic review of Level‐I randomized controlled studies). |
| format | Article |
| id | doaj-art-6b7d67ee724b49ec99fcc01e420582d9 |
| institution | DOAJ |
| issn | 2197-1153 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Wiley |
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| series | Journal of Experimental Orthopaedics |
| spelling | doaj-art-6b7d67ee724b49ec99fcc01e420582d92025-08-20T02:52:48ZengWileyJournal of Experimental Orthopaedics2197-11532024-10-01114n/an/a10.1002/jeo2.70098Comparison of the accuracy and efficacy of different assistive techniques in primary total knee arthroplasty: A network meta‐analysisYuhang Zheng0Yang Li1Ziqi Yuan2Xiao Geng3Hua Tian4Department of Orthopedics Peking University Third Hospital Beijing ChinaDepartment of Orthopedics Peking University Third Hospital Beijing ChinaDepartment of Orthopedics Peking University Third Hospital Beijing ChinaDepartment of Orthopedics Peking University Third Hospital Beijing ChinaDepartment of Orthopedics Peking University Third Hospital Beijing ChinaAbstract Purpose Various assistive techniques, such as conventional cutting instruments (CON), computer‐assisted navigation systems (CAS), patient‐specific instruments (PSI) and robot‐assisted systems (RAS), have been developed and applied in primary total knee arthroplasty (TKA). In this study, we aimed to assess the relative accuracy and efficacy of several assistive techniques for TKA through a network meta‐analysis (NMA) based on multiple published randomized controlled trials (RCTs). Methods The PubMed, EMBASE and Cochrane databases were searched for RCTs to conduct this NMA from inception to 1 January 2024. We combined direct and indirect comparisons using a Bayesian NMA framework to assess and compare the effects of different assistive techniques on radiological and clinical outcomes. An NMA was conducted, and the study protocol was published online at PROSPERO (CRD42023402882). Results One hundred and twelve RCTs involving 14,968 TKAs with four different assistive techniques (CON, CAS, PSI and RAS) were evaluated. Inconsistency and heterogeneity were acceptable for most outcomes. Based on the surface under the cumulative ranking curve, RAS could be the best technique for accurate mechanical axis alignment and component position, followed by CAS, PSI and CON. We observed no difference in clinical outcome scores. Additionally, CAS was the best intervention for visual analogue scale scores, and PSI had the shortest operative time. No significant differences were observed in postoperative complications, range of motion or total blood loss. Conclusion RAS was most likely to achieve an accurate alignment, followed by CAS, PSI and CON. No differences were observed in clinical outcome scores and postoperative complications among the four assistive techniques. Level of Evidence Level I (systematic review of Level‐I randomized controlled studies).https://doi.org/10.1002/jeo2.70098computer‐assisted navigation systemconventional cutting instrumentnetwork meta‐analysispatient‐specific instrumentrobot‐assisted systemtotal knee arthroplasty |
| spellingShingle | Yuhang Zheng Yang Li Ziqi Yuan Xiao Geng Hua Tian Comparison of the accuracy and efficacy of different assistive techniques in primary total knee arthroplasty: A network meta‐analysis Journal of Experimental Orthopaedics computer‐assisted navigation system conventional cutting instrument network meta‐analysis patient‐specific instrument robot‐assisted system total knee arthroplasty |
| title | Comparison of the accuracy and efficacy of different assistive techniques in primary total knee arthroplasty: A network meta‐analysis |
| title_full | Comparison of the accuracy and efficacy of different assistive techniques in primary total knee arthroplasty: A network meta‐analysis |
| title_fullStr | Comparison of the accuracy and efficacy of different assistive techniques in primary total knee arthroplasty: A network meta‐analysis |
| title_full_unstemmed | Comparison of the accuracy and efficacy of different assistive techniques in primary total knee arthroplasty: A network meta‐analysis |
| title_short | Comparison of the accuracy and efficacy of different assistive techniques in primary total knee arthroplasty: A network meta‐analysis |
| title_sort | comparison of the accuracy and efficacy of different assistive techniques in primary total knee arthroplasty a network meta analysis |
| topic | computer‐assisted navigation system conventional cutting instrument network meta‐analysis patient‐specific instrument robot‐assisted system total knee arthroplasty |
| url | https://doi.org/10.1002/jeo2.70098 |
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