Background
Methods
Search strategy
Inclusion and exclusion criteria
Data extraction and methodological quality assessment
Statistical analysis
Results
Literature search
The characteristics of included studies
Study/Year | Country | Recruitment period | Group | Patients (male/female) | Number of TKAs | Age (year) | BMI (kg/m2) | Follow-up (months) | Results Favor |
---|---|---|---|---|---|---|---|---|---|
Huang 2016 | China | 2005–2007 | QS | 2/29 | 31 | 69.3 ± 7.9 | 26.9 ± 3.3 | 65 ± 3.8 | QS |
MP | 2/28 | 30 | 71.2 ± 5.8 | 26.7 ± 2.8 | 68 ± 5.4 | ||||
Qi 2016 | China | 2005–2007 | QS | 2/26 | 30 | 65.3 ± 6.9 | 26.5 ± 3.0 | 74.8 | QS |
MP | 2/24 | 28 | 64.0 ± 5.7 | 28.1 ± 4.1 | 74.8 | ||||
Lin 2013 | Taiwan | 2007–2008 | QS | 5/30 | 35 | 67.7 (60, 78) | 26.3 (21.2, 29.7) | 24 | MP |
MP | 5/30 | 35 | 68.5 (55, 77) | 25.9 (20, 29.5) | 24 | ||||
Xu 2013 | China | 2009–2010 | QS | 7/19 | 35 | 63.5 ± 8.7 | 25.2 ± 3.4 | 24 | QS |
MP | 11/18 | 35 | 64.2 ± 9.3 | 25.2 ± 2.3 | 24 | ||||
Chiang 2012 | Taiwan | 2005 | QS | 3/27 | 38 | 69.7 ± 5.3 | 28.6 ± 3.8 | 24 | MP |
MP | 3/27 | 37 | 69.8 ± 5.4 | 29.6 ± 3.5 | 24 | ||||
Matsumoto 2011 | Japan | 2005–2007 | QS | 0/25 | 25 | 73.8 ± 1.7 | Unclear | 0 | MP |
MP | 0/25 | 25 | 73.7 ± 1.4 | Unclear | 0 | ||||
Yang 2010 | Korea | 2006–2007 | QS | 1/14 | 24 | 66.7 ± 6.9 | Unclear | 24 | MP |
MP | 2/14 | 23 | 68 ± 6.8 | Unclear | 24 | ||||
Karpman 2009 | USA | 2004–2005 | QS | 8/12 | 20 | 73 ± 7.4 | 28 ± 4.4 | 6 | QS |
MP | 9/10 | 19 | 73 ± 5.1 | 29 ± 4.6 | 6 | ||||
Chotanaphuti 2008 | Thailand | 2004–2005 | QS | 3/17 | 20 | 68.4 (58, 78) | Unclear | 0.25 | QS |
MP | 4/16 | 20 | 67.5 (56, 80) | Unclear | 0.25 | ||||
Shen 2007 | China | 2005–2006 | QS | Unclear | 26 | Unclear | Unclear | 17 | QS |
MP | Unclear | 33 | Unclear | Unclear | 17 | ||||
Huang 2007 | Taiwan | 2004–2005 | QS | 6/26 | 32 | 63 (56, 72) | Unclear | 24 | MP |
MP | 7/28 | 35 | 65 (59, 75) | Unclear | 24 | ||||
King 2007 | USA | 2003–2005 | QS | 48/52 | 100 | 67 (44, 84) | 30 (22, 43) | 1.5 | QS |
MP | 17/28 | 45 | 66 (42, 85) | 32 (20, 49) | 1.5 | ||||
Kim 2007 | Korea | 2004–2005 | QS | 27/93 | 120 | 65.4 (43, 88) | 28.1 (19, 36) | 21.5 | MP |
MP | 27/93 | 120 | 65.4 (43, 88) | 28.1 (19, 36) | 21.5 | ||||
Chin 2007 | Singapore | 2004 | QS | 6/24 | 30 | 69.0 (57, 80) | 27.53 (18.6, 34.2) | Unclear | MP |
MP | 3/27 | 30 | 63.4 (47, 80) | 29.44 (22.7, 40) | Unclear | ||||
Chen 2006 | USA | Prior to 2002 | QS | 11/17 | 32 | 70 (50, 86) | 28.5 (17.9, 39.9) | 33 | MP |
MP | 11/18 | 38 | 67 (42, 81) | 28.7 (21.6, 40.1) | 40 | ||||
Kim 2006 | Korea | 2003 | QS | 7/65 | 144 | 68.6 (57, 85) | 27.2 | 13.6 | MP |
MP | 8/64 | 144 | 67.4 (58, 84) | 28.1 | 13.6 |
Methodological quality assessment
Study/Year | Random Sequence Generation | Allocation Concealment | Blinding of Participants and Personnel | Blinding of Outcome Assessment | Incomplete Outcome Data | Selective Reporting | Other Bias |
---|---|---|---|---|---|---|---|
Lin 2013* | Yes | Sealed envelope | Unclear | Yes | Yes | Unclear | Unclear |
Xu 2013* | Yes | Sealed envelope | Unclear | Unclear | Yes | Unclear | Unclear |
Chiang 2012* | Yes | Unclear | Yes | Yes | Yes | Yes | Unclear |
Matsumoto 2011* | Yes | Unclear | Yes | Unclear | Yes | Unclear | Unclear |
Yang 2010* | Yes | Unclear | Unclear | Yes | Yes | Yes | Unclear |
Karpman 2009* | Yes | Unclear | Yes | Yes | Yes | Unclear | Unclear |
Kim 2007* | Yes | Unclear | Unclear | Yes | Yes | Unclear | Unclear |
Chin 2007* | Yes | Sealed envelope | Yes | Yes | Yes | Yes | Unclear |
Selection | Comparability | Outcomes | Total score | ||||
Huang 2016† | 2 | 2 | 3 | 7 | |||
Qi 2016† | 3 | 2 | 2 | 7 | |||
Chotanaphuti 2008† | 3 | 2 | 3 | 8 | |||
Shen 2007† | 3 | 2 | 3 | 8 | |||
Huang 2007† | 2 | 2 | 3 | 7 | |||
King 2007† | 3 | 2 | 3 | 8 | |||
Chen 2006† | 3 | 2 | 2 | 7 | |||
Kim 2006† | 3 | 2 | 3 | 8 |
Quantitative data synthesis
Primary outcomes
Outcomes of Demographics | Number of Contributing Studies | Number of QS TKAs | Number of MP TKAs | WMD or OR (95% CI) | P - Value | Heterogeneity |
---|---|---|---|---|---|---|
KS Knee Score beyond 24 months | 4 | 330 | 329 | -0.02 (− 0.69, 0.65) | 0.95 | 0% |
KS Function Score beyond 24 months | 3 | 186 | 185 | 1.78 (0.80, 2.76) | 0.0004 | 0% |
ROM beyond 16 months | 6 | 400 | 404 | 0.08 (−1.40, 1.57) | 0.91 | 4% |
Complications | 10 | 464 | 430 | 0.87 (0.49, 1.54) | 0.63 | 9% |
Infections | 10 | 503 | 515 | 1.53 (0.69, 3.39) | 0.29 | 0% |
Mechanical axis outliers | 5 | 257 | 266 | 1.05 (0.65, 1.72) | 0.83 | 27% |
Femoral component coronal angle outliers | 4 | 237 | 235 | 2.30 (0.35, 15.24) | 0.39 | 65% |
Tibial component coronal angle outliers | 5 | 337 | 280 | 0.73 (0.40, 1.33) | 0.30 | 40% |
Mechanical axis | 5 | 149 | 147 | 0.35 (−0.02, 0.73) | 0.07 | 0% |
Femoral component coronal angle | 6 | 395 | 395 | 0.23 (− 0.90, 1.35) | 0.69 | 92% |
Tibial component coronal angle | 7 | 495 | 445 | -0.40 (−1.29, 0.49) | 0.38 | 92% |
Lateral patellar tilt | 5 | 418 | 363 | -1.25 (−3.36, 0.85) | 0.24 | 78% |
Lateral patellar displacement | 2 | 131 | 75 | -1.47 (−4.59, 1.66) | 0.36 | 90% |
Secondary outcomes
Outcomes of Demographics | Number of Contributing Studies | Number of QS TKAs | Number of MP TKAs | WMD or OR (95% CI) | P - Value | Heterogeneity |
---|---|---|---|---|---|---|
KS Knee Score 1.5–3 months | 4 | 204 | 212 | 1.27 (− 0.57, 3.11) | 0.18 | 57% |
KS Function Score 1.5–3 months | 4 | 204 | 212 | −0.09 (−3.98, 3.81) | 0.97 | 73% |
ROM 1–2 weeks | 5 | 148 | 162 | 5.84 (3.84, 7.83) | < 0.00001 | 21% |
ROM 4–8 weeks | 7 | 283 | 247 | 0.51 (−1.90, 2.91) | 0.68 | 61% |
ROM 3 months | 2 | 152 | 158 | −0.60 (−2.32, 1.12) | 0.50 | 47% |
ROM 12 months | 2 | 58 | 68 | 4.00 (−5.80, 13.80) | 0.42 | 90% |
VAS 1 day | 6 | 183 | 197 | −0.91 (−1.68, − 0.41) | 0.02 | 81% |
VAS 3 days | 2 | 64 | 70 | −0.93 (−2.01, 0.14) | 0.09 | 82% |
VAS 4–8 weeks | 3 | 84 | 89 | −0.26 (−1.13, 0.61) | 0.56 | 77% |
Surgical time (min) | 8 | 507 | 450 | 12.02 (4.06, 19.98) | 0.003 | 95% |
Tourniquet time (min) | 8 | 447 | 462 | 27.19 (9.17, 45.22) | 0.003 | 99% |
Intraoperative blood loss (ml) | 4 | 334 | 339 | 1.99 (−14.28, 18.25) | 0.81 | 0% |
Total blood loss (ml) | 5 | 255 | 254 | −42.94 (−150.57, 64.70) | 0.43 | 90% |
Incision, extension (cm) | 7 | 276 | 284 | −4.62 (−6.35, −2.90) | < 0.00001 | 99% |
Incision, flexion (cm) | 3 | 193 | 192 | −1.90 (−3.99, 0.19) | 0.07 | 99% |
Length of stay (days) | 8 | 433 | 441 | −0.88 (−1.62, −0.15) | 0.02 | 94% |
SLR at 24 h (% of patients) | 3 | 105 | 107 | 3.05 (0.89, 10.53) | 0.08 | 75% |
Subgroup analysis
Outcomes of Demographics | Number of Contributing Studies | Number of QS TKAs | Number of MP TKAs | WMD or OR (95% CI) | P - Value | Heterogeneity |
---|---|---|---|---|---|---|
KS Knee Score beyond 24 months | 2 | 155 | 155 | −0.18 (−1.13, 0.77) | 0.71 | 25% |
KS Function Score beyond 24 months | 2 | 155 | 155 | 1.86 (0.86, 2.85) | 0.0002 | 0% |
ROM beyond 16 months | 3 | 193 | 192 | −0.41 (−2.18, 1.37) | 0.65 | 0% |
Complications | 5 | 243 | 244 | 1.49 (0.68, 3.27) | 0.32 | 1% |
Infections | 7 | 301 | 300 | 1.95 (0.75, 5.10) | 0.17 | 0% |
Mechanical axis outliers | 2 | 55 | 54 | 3.80 (0.61, 23.57) | 0.15 | 25% |
Femoral component coronal angle outliers | 3 | 93 | 91 | 5.24 (0.80, 34.28) | 0.08 | 20% |
Tibial component coronal angle outliers | 3 | 93 | 91 | 4.14 (0.87, 19.75) | 0.07 | 0% |
Mechanical axis | 3 | 88 | 89 | 0.34 (−0.37, 1.05) | 0.35 | 15% |
Femoral component coronal angle | 5 | 251 | 251 | 0.07 (−1.30, 1.44) | 0.92 | 93% |
Tibial component coronal angle | 5 | 251 | 251 | −0.31 (− 1.58, 0.97) | 0.64 | 93% |
Lateral patellar tilt | 2 | 143 | 144 | 0.73 (−0.30, 1.76) | 0.16 | 0% |
KS Knee Score 1.5–3 months | 3 | 178 | 179 | 1.01 (−0.74, 2.76) | 0.26 | 61% |
KS Function Score 1.5–3 months | 3 | 178 | 179 | −0.67 (−5.45, 4.10) | 0.78 | 82% |
ROM 1–2 weeks | 2 | 58 | 56 | 4.87 (1.78, 7.96) | 0.002 | 0% |
ROM 4–8 weeks | 3 | 93 | 91 | 1.68 (−2.16, 5.51) | 0.39 | 60% |
VAS 1 day | 3 | 93 | 91 | −0.07 (−0.49, 0.35) | 0.74 | 0% |
VAS 4–8 weeks | 2 | 58 | 56 | −0.46 (−2.31, 1.40) | 0.63 | 87% |
Surgical time (min) | 5 | 243 | 241 | 18.86 (8.81, 28.91) | 0.0002 | 94% |
Tourniquet time (min) | 3 | 193 | 192 | 24.39 (3.19, 45.60) | 0.02 | 99% |
Intraoperative blood loss (ml) | 2 | 158 | 157 | 3.10 (−24.89, 31.09) | 0.83 | 0% |
Total blood loss (ml) | 4 | 111 | 110 | 4.24 (−56.29, 64.77) | 0.89 | 48% |
Incision, extension (cm) | 4 | 188 | 188 | −3.76 (−6.79, −0.73) | 0.02 | 99% |
Incision, flexion (cm) | 3 | 193 | 192 | −1.90 (−3.99, 0.19) | 0.07 | 99% |
Length of stay (days) | 4 | 205 | 204 | −0.34 (−1.02, 0.34) | 0.33 | 71% |
SLR at 24 h (% of patients) | 2 | 73 | 72 | 1.62 (0.79, 3.30) | 0.19 | 0% |