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Medial pivot design does not yield superior results compared to posterior-stabilised total knee arthroplasty: a systematic review and meta-analysis of randomised control trials

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this meta-analysis was a comparison between medial pivot (MP) and posterior-stabilised (PS) knee designs regarding functional and radiological outcomes as well as gait parameters.

Methods

A systematic literature search was conducted in PubMed, Cochrane Library, Science Direct and Clinical Trials.gov from conception up to April 2022, to identify eligible randomised control trials (RCTs). The extracted data were analysed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement.

Results

Fifteen studies met inclusion criteria, enrolling 1101 patients who underwent 1242 total knee arthroplasties (TKAs). A total of 1158 TKAs (581 MP/577 PS) were included in the quantitative analysis. Mean follow-up ranged from 6 months up to 6.6 years. MP knees showed comparable range of motion (ROM) with PS design 1, 2 and 4 years postoperatively (p = 0.2, p = 0.25, p = 0.34, respectively). No statistical difference was found in patient-related outcome measures (PROMs) (p > 0.05). Mean walking speed (MWS), length of stay (LOS), radiographic alignment and complications rates were also similar between the two groups (p > 0.05).

Discussion

The present meta-analysis demonstrated that the theoretical biomechanical advantage of MP implants does not have a better impact on patient satisfaction compared to the traditional PS knees.

Level of evidence

I.

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Abbreviations

TKA:

Total knee arthroplasty

PS:

Posterior stabilised

RCT:

Randomised control trial

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PICO:

Population, intervention, comparison, outcome

ROM:

Range of motion

PROMs:

Patient-related outcome measures

MeSH:

Medical subject headings

KSS:

Knee Society Score

KFS:

Knee Society Function Score

WOMAC:

Western Ontario and McMaster Universities Arthritis Index

OKS:

Oxford Knee Score

FJS:

Forgotten Joint Score

TUG:

Timed up and go test

VR-12:

Veterans RAND 12 Item Health Survey

LOS:

Length of stay

MWS:

Mean walking speed test

RoB2:

Cochrane risk-of-bias tool for randomised trials version 2

SD:

Standard deviation

RR:

Relative risk

MD:

Mean difference

CI:

Confidence interval

DVT:

Deep-vein thrombosis

MCID:

Minimum clinically important difference

References

  1. Atzori F, Salama W, Sabatini L, Mousa S, Khalefa A (2016) Medial pivot knee in primary total knee arthroplasty. Ann Transl Med 4:6

    PubMed  PubMed Central  Google Scholar 

  2. Batra S, Malhotra R, Kumar V, Srivastava DN, Backstein D, Pandit H (2021) Superior patient satisfaction in medial pivot as compared to posterior stabilized total knee arthroplasty: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 29:3633–3640

    Article  PubMed  Google Scholar 

  3. Benjamin B, Pietrzak JRT, Tahmassebi J, Haddad FS (2018) A functional comparison of medial pivot and condylar knee designs based on patient outcomes and parameters of gait. Bone Joint J 100-b:76–82

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Chang JS, Kayani B, Moriarty PD, Tahmassebi JE, Haddad FS (2021) A prospective randomized controlled trial comparing medial-pivot versus posterior-stabilized total knee arthroplasty. J Arthroplast 36:1584-1589.e1581

    Article  Google Scholar 

  5. Dall’Oca C, Ricci M, Vecchini E, Giannini N, Lamberti D, Tromponi C et al (2017) Evolution of TKA design. Acta Biomed 88:17–31

    PubMed  PubMed Central  Google Scholar 

  6. Dennis DA, Komistek RD, Stiehl JB, Walker SA, Dennis KN (1998) Range of motion after total knee arthroplasty: the effect of implant design and weight-bearing conditions. J Arthroplast 13:748–752

    Article  CAS  Google Scholar 

  7. Dowsey MM, Gould DJ, Spelman T, Pandy MG, Choong PF (2020) A randomized controlled trial comparing a medial stabilized total knee prosthesis to a cruciate retaining and posterior stabilized design: a report of the clinical and functional outcomes following total knee replacement. J Arthroplast 35:1583-1590.e1582

    Article  Google Scholar 

  8. Edelstein AI, Bhatt S, Wright-Chisem J, Sullivan R, Beal M, Manning DW (2020) The effect of implant design on sagittal plane stability: a randomized trial of medial- versus posterior-stabilized total knee arthroplasty. J Knee Surg 33:452–458

    Article  PubMed  Google Scholar 

  9. Elbardesy H, Salamah HM, McLeod A, Thada PK, Mohammed ER, Hanifa FA et al (2021) Medial pivot versus (cam post) posterior stabilised total knee arthroplasty, systematic review and meta-analysis of 3837 knees. Acta Orthop Belg 87:665–680

    Article  PubMed  Google Scholar 

  10. Escobar A, Quintana JM, Bilbao A, Aróstegui I, Lafuente I, Vidaurreta I (2007) Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoar Cartil 15:273–280

    Article  CAS  Google Scholar 

  11. Fox AJ, Bedi A, Rodeo SA (2012) The basic science of human knee menisci: structure, composition, and function. Sports Health 4:340–351

    Article  PubMed  PubMed Central  Google Scholar 

  12. Freeman MA, Pinskerova V (2005) The movement of the normal tibio-femoral joint. J Biomech 38:197–208

    Article  CAS  PubMed  Google Scholar 

  13. Gill UNSH, Rehman MKU, Malik AL, Mian MH (2019) Comparison of functional outcome of medial pivot total knee arthroplasty with posterior stabilizing (PS) total knee arthroplasty—a randomized trial. Pak J Med Heal Sci 13:385–388

    Google Scholar 

  14. Gray HA, Guan S, Young TJ, Dowsey MM, Choong PF, Pandy MG (2020) Comparison of posterior-stabilized, cruciate-retaining, and medial-stabilized knee implant motion during gait. J Orthop Res 38:1753–1768

    Article  PubMed  Google Scholar 

  15. Higgins JPTTJ, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors) Cochrane handbook for systematic reviews of interventions version 6.3 (updated February 2022). Cochrane, 2022. Available from: http://www.training.cochrane.org/handbook. Accessed 13 Jun 2022

  16. Hossain F, Patel S, Rhee SJ, Haddad FS (2011) Knee arthroplasty with a medially conforming ball-and-socket tibiofemoral articulation provides better function. Clin Orthop Relat Res 469:55–63

    Article  PubMed  Google Scholar 

  17. Ishida K, Matsumoto T, Tsumura N, Iwakura T, Kubo S, Iguchi T et al (2014) No difference between double-high insert and medial-pivot insert in TKA. Knee Surg Sports Traumatol Arthrosc 22:576–580

    Article  PubMed  Google Scholar 

  18. Kazarian GS, Lawrie CM, Barrack TN, Donaldson MJ, Miller GM, Haddad FS et al (2019) The impact of surgeon volume and training status on implant alignment in total knee arthroplasty. J Bone Joint Surg Am 101:1713–1723

    Article  PubMed  Google Scholar 

  19. Khasian M, Meccia BA, LaCour MT, Komistek RD (2021) Effects of the medial plateau bearing insert conformity on mid-flexion paradoxical motion in a posterior-stabilized total knee arthroplasty design. J Arthroplast 36:2386–2392

    Article  Google Scholar 

  20. Komistek RD, Dennis DA, Mahfouz M (2003) In vivo fluoroscopic analysis of the normal human knee. Clin Orthop Relat Res. https://doi.org/10.1097/01.blo.0000062384.79828.3b69-81

    Article  PubMed  Google Scholar 

  21. Kulshrestha V, Sood M, Kanade S, Kumar S, Datta B, Mittal G (2020) Early outcomes of medial pivot total knee arthroplasty compared to posterior-stabilized design: a randomized controlled trial. Clin Orthop Surg 12:178–186

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lee QJ, Wai Yee EC, Wong YC (2020) No difference in patient preference for medial pivot versus posterior-stabilized design in staged bilateral total knee arthroplasty: a prospective study. Knee Surg Sports Traumatol Arthrosc 28:3805–3809

    Article  PubMed  Google Scholar 

  23. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6:e1000100

    Article  PubMed  PubMed Central  Google Scholar 

  24. Liu X, Liu Y, Li B, Wang L, Wang Y, Liu J (2022) Comparison of the clinical and patient-reported outcomes between medial stabilized and posterior stabilized total knee arthroplasty: a systematic review and meta-analysis. Knee 36:9–19

    Article  PubMed  Google Scholar 

  25. Maredupaka S, Meshram P, Chatte M, Kim WH, Kim TK (2020) Minimal clinically important difference of commonly used patient-reported outcome measures in total knee arthroplasty: review of terminologies, methods and proposed values. Knee Surg Relat Res 32:19

    Article  PubMed  PubMed Central  Google Scholar 

  26. Nisar S, Ahmad K, Palan J, Pandit H, van Duren B (2022) Medial stabilised total knee arthroplasty achieves comparable clinical outcomes when compared to other TKA designs: a systematic review and meta-analysis of the current literature. Knee Surg Sports Traumatol Arthrosc 30:638–651

    Article  PubMed  Google Scholar 

  27. Nishitani K, Furu M, Nakamura S, Kuriyama S, Ishikawa M, Ito H et al (2018) No differences in patient-reported outcomes between medial pivot insert and symmetrical insert in total knee arthroplasty: a randomized analysis. Knee 25:1254–1261

    Article  PubMed  Google Scholar 

  28. O’Connor MI (2011) Implant survival, knee function, and pain relief after TKA: are there differences between men and women? Clin Orthop Relat Res 469:1846–1851

    Article  PubMed  PubMed Central  Google Scholar 

  29. Pritchett JW (2013) A comparison of the noise generated from different types of knee prostheses. J Knee Surg 26:101–104

    PubMed  Google Scholar 

  30. Pritchett JW (2004) Patient preferences in knee prostheses. J Bone Joint Surg Br 86:979–982

    Article  CAS  PubMed  Google Scholar 

  31. Pritchett JW (2011) Patients prefer a bicruciate-retaining or the medial pivot total knee prosthesis. J Arthroplast 26:224–228

    Article  Google Scholar 

  32. Review Manager (RevMan) (2020) [Computer program]. Version 5.4, T.C.C.

  33. Sabatini L, Risitano S, Parisi G, Tosto F, Indelli PF, Atzori F et al (2018) Medial pivot in total knee arthroplasty: literature review and our first experience. Clin Med Insights Arthritis Musculoskelet Disord 11:1179544117751431

    Article  PubMed  PubMed Central  Google Scholar 

  34. Scott DF, Gray CG (2022) Outcomes are better with a medial-stabilized vs a posterior-stabilized total knee implanted with kinematic alignment. J Arthroplast. https://doi.org/10.1016/j.arth.2022.02.059

    Article  Google Scholar 

  35. Singh D, Patel KC, Singh RD (2021) Achieving coronal plane alignment in total knee arthroplasty through modified preoperative planning based on long-leg radiographs: a prospective study. J Exp Orthop 8:100

    Article  PubMed  PubMed Central  Google Scholar 

  36. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898

    Article  PubMed  Google Scholar 

  37. Sun D, Fekete G, Mei Q, Gu Y (2018) The effect of walking speed on the foot inter-segment kinematics, ground reaction forces and lower limb joint moments. Peer J 6:e5517

    Article  PubMed  PubMed Central  Google Scholar 

  38. Sun X, Gao X, Sun X, Su Z (2021) Comparison of clinical and radiographic results between total knee arthroplasties using medial pivot and posterior-stabilized prosthesis: a meta-analysis. Medicine 100:e23809–e23809

    Article  PubMed  PubMed Central  Google Scholar 

  39. Uivaraseanu B, Vesa CM, Tit DM, Maghiar O, Maghiar TA, Hozan C et al (2022) Highlighting the advantages and benefits of cementless total knee arthroplasty (review). Exp Ther Med 23:58

    Article  PubMed  Google Scholar 

  40. Wünschel M, Leasure JM, Dalheimer P, Kraft N, Wülker N, Müller O (2013) Differences in knee joint kinematics and forces after posterior cruciate retaining and stabilized total knee arthroplasty. Knee 20:416–421

    Article  PubMed  Google Scholar 

  41. Wang Z, Zhang YQ, Ding CR, Wang YZ, Xu H (2021) Early patellofemoral function of medial pivot prostheses compared with posterior-stabilized prostheses for unilateral total knee arthroplasty. Orthop Surg 13:417–425

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Yuan D, Zhang QS, Zhang K, Cao YW, Chen GH, Ling ZZ et al (2020) Total knee arthroplasty using a medial pivot or posterior cruciate-stabilizing prosthesis in Chinese patients. J Knee Surg 33:892–898

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors want to thank Theodora Panagiotidou for proofreading the article.

Funding

This research received no specific Grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece

    Panagiotis Kakoulidis, Sousana Panagiotidou, Kyriakos Papavasiliou, Eleftherios Tsiridis & Christos Topalis

  2. Orthopaedic Unit, General Hospital of Florina, Egnatias 9, 53100, Florina, Greece

    Georgios Profitiliotis

  3. Center of Orthopaedics and Regenerative Medicine (C.O.RE.)-Center of Interdisciplinary Research and Innovation (C.I.R.I.)—Aristotle University Thessaloniki, Balkan Center, Buildings A and B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece

    Eleftherios Tsiridis & Christos Topalis

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  1. Panagiotis Kakoulidis
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  2. Sousana Panagiotidou
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Contributions

PK was the major contributor in writing the manuscript, making substantial contributions to conception, design, acquisition of data, analysis and interpretation of data. SP was a contributor in writing the manuscript, involved in drafting the article, acquisition of data, analysis and interpretation of data. GP was a contributor in writing the manuscript, involved in drafting the article, acquisition of data, analysis and interpretation of data. KP was a contributor in writing the manuscript, involved in drafting the article and revising it critically for important intellectual content. ET was a contributor in writing the manuscript, involved in drafting the article and revising it critically for important intellectual content. CT was a contributor in writing the manuscript, involved in drafting the article and revising it critically for important intellectual content and gave the final approval of the version to be published.

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Correspondence to Panagiotis Kakoulidis.

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Kakoulidis, P., Panagiotidou, S., Profitiliotis, G. et al. Medial pivot design does not yield superior results compared to posterior-stabilised total knee arthroplasty: a systematic review and meta-analysis of randomised control trials. Knee Surg Sports Traumatol Arthrosc 31, 3684–3700 (2023). https://doi.org/10.1007/s00167-022-07238-2

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