| The clinical application and therapeutic effect of total knee arthroplasty(TKA)in the terminal disease of the knee has been recognized worldwide.At present,the prosthesis-bone fixation forms in total knee arthroplasty mainly include bone cement fixation and Cementless fixation,and the former is the most widely used.However,the ideal fixation method is still controversial.Cement fixation of patella,femur and tibia has become the gold standard of TKA due to its clinical effecticeness and 20 years life span of the prosthesis.However,the lack of remodeling of the cement-bone interface and wear of the prosthesis affect the long life of the cement-fixed prosthesis,especially in young and active patients.The adhesion force between bone cement and bone tissue weakens over time,while the non-bone cement prosthesis can improve the firmness of the prosthesis through bone growth,thus improving the long-term survival rate of the prosthesis.Cementless prosthesis has the advantages of reducing stress shielding,shortening the time of operation and tourniquet,reducing potential wear of prosthesis and preserving bone mass.Non-osseous cement prostheses,though expensive,are preferred in younger patients.There are complications of the cementless prosthesis,such as early loosening of fixation,especially in the tibia and patella.However,with the emerge of more new types of prostheses and the improvement of surgical techniques,the survival rate of cementless fixation at 15 years after surgery has been greatly improved.Although the long-term effect of the cementless fixation is promising,the cementless fixation was found to have obvious displacement compared with the bone cement fixation in the early follow-up by the radiation index.If the bone growth was followed up,no obvious advantages or disadvantages were found between the two fixation methods.In addition,there is no specific study on the use of two fixation methods for the tibial prosthesis.The new type of cement-free tibial fixation is composed of multi-porous metal,which has high volume porosity and good bone growth characteristics similar to cancellous bone.Currently,the overall design of tantalum fixation has been compared with that of bone cement fixation,and the two have similar results in the mid-term follow-up.At present,the advantages and disadvantages of the two fixation methods are still controversial,and further studies are needed to compare the two fixation methods,in order to have a clinical result.OBJECTIVE: The study aimed to assess the value of bone cement and uncement fixation using in total knee arthroplasty(TKA)using meta-analysis to exploring the optimal fixation for TKA.METHODS: PubMed,The Cochrane Library(2018,9),EMbase,CNKI,VIP,CBM,and WanFang Data databases were searched by search strategy to collect reports of bone cement and cementless fixation in total knee arthroplasty using RevMan.5.1 software for meta-analysis.RESULTS: Seventeen systematic reviews and pooled analyses were included in this study.Nine studies compared knee joint survival at ?5 years follow-up after replacement and a statistically significant difference was identified between the cement and uncemented groups(RR=1.02,95% CI: 1.00-1.05),p=0.02).There was no statistical heterogeneity in knee survival more than 5-year between the cement and cementless fixation groups(RR=1.01,95% CI: 0.97-1.04),p=0.75).There were no significant differences in postoperative prosthesis-related complications between the cemented andnon-cemented groups(RR=0.97,95% CI: 0.75-1.27),p=0.84).There were statistical differences in the imaging index between these two groups.The difference in the position of the tibia and the sagittal position between the two groups was not statistically significant.Conclusion: The implant components of the uncemented group have relatively high rotation rates,but the survival rate and clinical efficacy of the two groups are similar.The use of uncemented fixation is also an acceptable surgical procedure for first-time total knee arthroplasty.To more comprehensively and accurately evaluate the long-term survival rate,safety,clinical and radiological indicators of bone cement solid and uncemented cement,further research is needed. |
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