Patient Outcomes Following Tricompartmental Total Knee Replacement: A Meta-Analysis
Patient Outcomes Following Tricompartmental Total Knee Replacement: A Meta-Analysis
Patient Outcomes Following Tricompartmental Total Knee Replacement: A Meta-Analysis
Authors' objectives
To provide estimates of patient outcomes following tricompartmental knee replacement, and to examine variation in
outcomes due to patient and prosthesis characteristics.
Searching
MEDLARS was searched from 1966 to 1992 for English language citations concerning prosthetic knee surgery.
Citations were excluded if they were assigned the MeSH terms 'amputation', 'animal', 'bone neoplasm' or 'case report'.
Reference lists of retrieved review articles, published from 1986 to 1992, were examined for further publications.
Study selection
Study designs of evaluations included in the review
The studies had to have enrolled at least 10 patients; case reports were excluded.
Data extraction
The data were extracted by one of the 3 research assistants or one of the 3 study investigators. There is no mention of
this process being checked for accuracy. Data were extracted so as to enable 'patients' to be used as the unit of analysis,
except for post-operative complications where 'knees' were used.
Methods of synthesis
How were the studies combined?
Tricompartmental prostheses were classified according to the manner in which the cruciate and collateral ligaments
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were treated. Data were summarised across studies within prosthetic groups, and for the entire group of articles, by
providing weighted means and ranges for each of the abstracted variables.
Across all studies, the typical patient experienced a 100% improvement in GKRS, mean value 44.0 (range: 41.9-46.1)
and 89.3% of patients were reported to have good or excellent outcomes (mean follow-up of 4.1 years).
Pain relief.
Twenty-six studies reported patients' post-operative pain (n=1,938; mean follow-up 4.1 years). Of these studies, 75% of
patients reported no post-operative pain, 20% reported mild pain, 3.7% reported moderate pain, and 1.3% reported
severe post-operative pain.
Post-operative complications.
Approximately 18% of patients experienced a post-operative complication. None of the studies reported the rate of
thromboembolism during the short-term, i.e. 30-day period.
The overall rate of revision was 3.8% (mean follow-up 4.1 years). Reasons for these revisions were: aseptic loosening
(42%), mechanical failure (29%), infection (21%) and unspecified (8%). The distribution of these failures over time
could not be determined.
The 30-day and 1-year mortality rates following tricompartmental total knee replacement could not be determined, nor
was it possible to determine which deaths were directly due to the replacement.
Authors' conclusions
Tricompartmental knee replacement was a safe and effective procedure for the patients reported. The knee pathology
and the type of prosthesis were significant predictors of outcomes. Limitations in the reporting style of these articles
severely constrain the ability to explore variation in outcomes due to study, patient or prosthesis characteristics, and
restrict their generalisability.
CRD commentary
A thorough review with a good discussion of the limitations of both the primary studies and the meta-analysis.
However, there is insufficient information given on the individual studies and their validity. 'Good' or 'excellent
outcomes' are not defined within the paper.
Funding
Agency for Health Care Policy and Research grant number 06432; National Institute on Aging, grant number K08
AG00538-01.
PubMedID
8158821
Indexing Status
Subject indexing assigned by NLM
MeSH
Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Knee Prosthesis /instrumentation /methods /statistics &
numerical data; Male; Meta-Analysis as Topic; Middle Aged; Osteoarthritis /surgery; Prognosis; Treatment Outcome
AccessionNumber
11996008198
Record Status
This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract
contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on
the reliability of the review and the conclusions drawn.