Journal Club Team A 29/01/2015
Jul 24, 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 Analysis
• Metaanalysis performed using “ Review Manager Software”
• Weighted mean difference
• Odds ratio ( 95% confidence interval)
• Chi square test
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