Do Patients Really Gain Outcome Benefits When Using the High-Flex Knee Prostheses in Total Knee Arthroplasty? A Meta-Analysis of Randomized Controlled Trials
Section snippets
Inclusion Criteria
We only included randomized controlled trials comparing high-flex (HF) prostheses with standard (STD) prostheses in primary TKA, with adequately reported data on range of motion (ROM), Knee Society score (KSS), Hospital for Special Surgery knee score (HSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form (SF)-36, and complications. Any prospective studies, retrospective studies, cadaver studies, letters, comments, case reports, guidelines, and review papers
Study Characteristics
Fig. 1 shows the details about the process of study selection. Our search strategy totally generated 1042 articles. 106 articles were considered potentially eligible for further evaluation after removing duplications and scanning titles and abstracts. After reading the full-texts for detailed evaluation, 18 studies were included based on our inclusion criteria, comprising 2069 knees (1906 patients) in this meta-analysis.
Characteristics and quality assessment of the included 18 studies were
Discussion
Our meta-analysis showed that post-operative ROM was a little higher in HF TKAs compared with STD TKAs in the overall comparison, but there was evident statistical heterogeneity. In the subgroup analysis, both PS-Flex vs. PS group and CR-Flex vs. CR group suggested that there was no significant difference in post-operative ROM when comparing HF and STD TKAs. Moreover, there was also no statistically significant differences in clinical outcomes (KSS, HSS, WOMAC, and SF-36), patient’s
Acknowledgements
All authors have no financial or personal relationships with other people or organizations that could inappropriately influence this work.
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2016, Journal of ArthroplastyCitation Excerpt :In addition, none of the patients required a manipulation after their operation, and there were no major complications needing revision for any reason at this short-term follow-up period. Several updated meta-analyses on the comparison between high-flexion and standard TKA designs have been published recently [12-14]. Among them, Li et al [14] included the largest of the 18 randomized controlled trials on the subject.
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2015, Seminars in Arthroplasty JSESCitation Excerpt :Some TKA designs have been marketed as high-flexion or gender-specific. The literature does not support any increased benefit of high-flexion TKA in three different randomized controlled trials [28–30]. Further, there was no benefit with high-flexion designs in patients demonstrating high preoperative flexion in whom you would expect greater postoperative flexion.
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2015, Journal of OrthopaedicsCitation Excerpt :In this system pain, knee joint stiffness and function is questioned and the lower point represents the better outcome. So, the classification is as follows: 0–14 excellent, 15–28 good, 19–38 moderate, >39 insufficient.13–15 In statistical analysis our purpose was to investigate whether results of two distinct studies were different.
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Source of Funding: This research was funded by the China Health Ministry Program (201302007).
The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2014.11.025.