| BackgroundOsteoarthritis of knee joint, also known as the knee joint degeneration, is characteristic by swell, severe pain and limited movement of knee joint, which is thought to reduce the patients quality of life. And with the improvement of living standards and medical care quality, life expectancy are greatly extended, a number of patients with knee osteoarthritis also increased significantly, make it become a heavy burden of the society. Knee replacement can effectively relieve unpleasant symptoms, improve the function of knee joint, which is an effective method to treat end-stage knee joint osteoarthritis and widely admired by doctors and patients. Over the past25years, total knee replacement was thought to be one of the most successful techniques in Orthopaedic field, the idea of the prosthesis design has developed from simple mechanical modification to complex anatomic reconstruction. In fact, it is well known that each cell is a gender, gender differences exist in any tissue of our body. It was the right time to probe into the issues between the prosthesis matching and its relationship with sensation, knee function and survival rate after solving the problem of polyethylene wear. This will be the focus of the current and future. According to the statistical report from the American Academy of Orthopaedic Surgeons(AAOS), at least63%patients with knee arthroplasty are women. The difference is noticed not only in tissue tension, elasticity (flexibility, adaptability), fat distribution and the incidence of patellofemoral arthritis, but also in psychological problems between men and women, with women have more psychological problems such as three times higher risk of adversity and a description more pain, which is more worth the attention of every joint surgeon.Orthopaedic doctor would have noticed the different anatomical distal femur for many women with total knee replacement. The first person is John Insall, who created a special supplement to traditional plants, within an additional5mm in AP line of the prosthesis when with the same width. and since then, a large number of forms, according to the anatomic and radiographic measurement revealed the difference between men and women. Morphological data indicates that woman tend to have narrower medial to lateral dimension(ML) of femoral condyle for any given anterior to posterior dimension(AP). Q angel is significantly greater in female population than male population. The anterior femoral condylar anatomy is more pronounced in male knees. Women tibial are closer to ellipse, and more narrow in the sagittal plane. Thus, traditional femoral prosthetics in women tend to be oversized which may cause overhang of knee capsule and overstuffing of patellofemoral compartment and lead to postoperative pain and reduction of range of motion (ROM). To solve these problems, prosthesis are adjusted from the earlier AP rate of0.8according to female knee to0.9in order to adapt to more close to the trapezoidal anatomy of male distal femur. Characteristics of this system mainly focus on:(1) reduced medial to lateral dimension for any given size;(2) greater angle of the trochlear groove;(3) reduced thickness of the anterior flange.This morphological specific implant has theoretical advantage over standard component, whether female patients can benefit from this system is under debate. Thus we conduct this systematic review and meta-analysis to evaluate the clinical and radiographic outcomes between two implants.ObjectiveThe aim of this meta-analysis was to review published articles that compared gender specific total knee arthroplasty (TKA) with conventional TKA for short-or long-term outcomes and to determine which implant leads to a better outcome and to offer a better choice when considering the knee implants.Materials and Methods1.1An detailed inclusion and exclusion criteria were established according to PICO steps after put forward a question, and then comprehensive search Strategy of literature were made to search the relevant Randomized Controlled Trials(RCTs).1.2We conducted a comprehensive search of Pubmed (up to Aug2013), Embase (up to Aug2013), and the Cochrane Central Register Controlled Trails (up to Aug2013) using the following search strategies:(gender-specific OR sex-specific OR NexGen) AND (knee arthroplasty OR knee replacement), in addition, the reference list of the included studies were also searched for potential related studies. The procedure of selection was followed as the flow diagram of selection process of publications (FDSPP) by cochrane.1.3The methodology quality of each inclusion study Was critically assessed according to the quality criteria of RCT which include four items:randomization, mlocation concealment, blindness and follow-up.1.4The following information was extracted from each study:name of first author, year of publication, study design, number of patients, mean age of patients, diagnosis, mean follow-up time, clinical data including KSS, ROM and postoperative complications (such as deep infections, overhang of implants, postoperative knee pain, reoperation), as well as radiographic outcomes.1.5The baseline among those eligible studies was checked out and made to be comparative. Outcomes was calculated by software revman, with dichotomous data pooled by OR, while continuous variables pooled by WMD and95%confidence intervals(95%CI) were calculated for both outcomes. Before outcome measures of each trial were pooled, clinical heterogeneity should be considered. If interventions of each trial were different, subgroup analysis should be applied.. When data can not be directly pooled due to different forms of outcomes, descriptive analysis was conducted. Results:2.1Eligible articles The initial search strategy provided508possible studies, of which147were duplicated. There were361articles left after removing duplicates. Thereafter, we read all the abstracts and excluded335these studies, leaving26potentially relevant literature. Only12randomized controlled trials and retrospective trails were eligible after full reading and evaluation of the text. One study was in German; two studies were letters to the editor; one study by Song compared outcome of ROM in patients undergoing TKA with standard cruciate-retaining TKA during their operation; one study by Clarke radiographically evaluated the unisex prosthesis TKA versus gender-specific TKA. It provided only radiographic parameter, without any information regarding clinical results mentioned in this retrospective study, further more, mean follow-up time was unclear. Another study by Lionberger reported a group of39patients undergoing TKA with gender-specific high-flexion prosthesis which was compared to a control group with NexGen CR implant.In the study group, only28patients received gender-specific TKA, while the remaining11were NexGen LPS-Flex which did not belong to morphological specific group. Thus those three articles was eliminated finally, leaving6studies together with717patients included in this analysis.2.2clinical outcomes2.2.1Descriptive analysis of KSS, ROM All6studies provided clinical outcomes, such as range of motion, flexion capability, KSS, WOMAC or HSS. However, inconsistence style of results was recorded among these studies, therefore we used a descriptive analysis.5trails reported comparable postoperative ROM with ranged mean value124°to134°in gender-specific group compared to conventional group, only one study found that gender-specific arthroplasty increased2.9°of ROM compared to none gender-specific group (p=0.007).5studies reported KSS clinical score, both of the two implants could significantly enhance the knee condition postoperatively, while there was no difference between two groups.4studies reported postoperative KSS functional scorewhich varied from79.9to94, no difference was noted in two groups (p>0.05). 2.2.2Deep infection3tails with774TKAs reported deep infection. There was no statistical heterogeneity (I2=0%) among studies, a fixed model was used. The meta analysis showed that there was no difference in deep infection in gender-specific TKA compared with conventional TKA (OR=0.97,95%CI0.19-4.82,p=0.97).2.2.3Overhang of prosthesis3tails with508TKAs reported deep infection. no statistical heterogeneity (I2=0%) was noted among studies, a fixed model was applied. Pooled data indicated that gender-specific TKA significantly reduced overhang rate with comparison to conventional TKA (OR=0.04,95%CI0.00-0.27, p=0.001).2.2.4postoperative pain3tails with650TKAs reported number of patients sustaining postoperative pain. There was no statistical heterogeneity (I2=0%) among studies, a fixed model was used. The meta-analysis showed that the number of patients with postoperative pain was similar in gender-specific cohort to conventional cohort (OR=1.05,95%CI0.68-1.61,p=0.83).2.2.5Reoperation5studies with1022TKAs reported reoperation rate caused by any reason. No statistical heterogeneity (12=0%) was observed among studies, a fixed model was used. Meta-analysis revealed that failure rate of two implants was comparable (OR=0.78,95%CI0.21-2.933,p=0.71).2.2.6Radiolucent line3studies provided information regarding radiolucent line in femur side or tibial side, two reported radiolucent line<lmm in their study, none was noted>1mm. Meta-analysis revealed that no statistical difference was observed between two groups in terms of radiolucent line (OR=0.96,95%CI0.46-2.01, p=0.91).conclusions:Despite a lower overhang rate, there was insufficient evidence in favor of gender specific TKA with regards to KSS score, ROM, deep infection, postoperative pain, reoperation rate and radiolucent line. |
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