Journal Club

Team A 29/01/2015

Principal research question

• Difference in clinical efficiency and survivorship of posterior stabilized and cruciate retaining knee replacement

Why was the study needed ?

• Numerous studies comparing CR vs PS TKR

• No conclusive evidence

• Most recent evidence in literature

Data Source

• Electronic search – Medline , Embase & Cochrane register

• Published articles up to Aug 2011

• Reference list of identified articles

Index Terms

• ‘total knee replacement’

• ‘total knee arthroplasty’

• ‘posterior cruciate ligament’

• ‘randomized control trials’

Study Selection

• RCT comparing CR vs PS – primary TKR

• Revision TKR and high flexion design excluded.

Post op clinical scoresRange of motion

Flexion and extensionComplications

Data Extraction

• Sample size• Study design• Patient age • Gender• Body mass index• Brand of prosthesis• Follow up duration• Knee society score• Range of motion • Flexion & Extension angle• Complications

Data Quality

• Methodological quality of included studies – PEDro - scale

Data Analysis

• Metaanalysis performed using “ Review Manager Software”

• Weighted mean difference

• Odds ratio ( 95% confidence interval)

• Chi square test

Results

• 8 studies • 888 patients – 963 joints

• Follow up – 2 yrs - 7.3 yrs

Results

• Post op ROM ( 2 studies ) 11deg more in PS gp

• Post op Flexion angle ( 5 studies) 2.88 deg more in PS gp

• Extension – no difference

Results

• No significant difference between PS & CR gps

Knee society pain scores Knee society function scores

Results

• No significant difference between PS & CR gps

Rate of complicationsAnterior knee painInfection DVT Revision arthroplasty

Study Outcome

• Clinical measures do not significantly differ

• Difference in range of movement – 2 studies

Strength of study

• Search methods used to find evidence stated• Search methods were reasonably

comprehensive

• Reported criteria for including studies

• Included RCTS were validated with appropriate methods

Strength of study

• Method used to analyze data – reported • Authors have answered the primary question• Conclusion made by authors supported in

literature

• Conflict of interest stated

Limitation of study

• Level 2 evidence• Funding not reported • Rotating platform knees included• Limited to English language articles• Range of motion available only for 2 studies

THANK YOU