Non-inferiority of The Cementless Total TKA Compared to The Cemented TKA, A m-Metanalysis

Objective: Cemented total knee arthroplasty still represents the reference standard in the field of prothesis knee replacement; but since cementless total knee arthroplasties were introduced there have been strong discussions over the years among cemented and non-cemented total knee arthroplasties to establish which gives the best benefits for the patient and for the surgeon. The purpose of this meta-analysis is to systematically analyze the use of cemented and cementless total knee arthroplasties by investigating clinical and radiological outcomes and rate of complications, in order to assess which techniques confers more benefits to the patient and the surgeon. Materials and Methods: The current systematic review has been written in accordance to the Cochrane handbook and the PRISMA statement for reporting of systematic reviews incorporating network. Results: Six randomized controlled trials were finally included in this systematic review. The statistical analysis revealed no significant differences in all clinical scores of interest (Knee Society Score, clinical and functional, Oxford Knee Score, Visual Analogue Score) and a similar revision rate. Conclusion: the results of the current metanalysis suggest the non-inferiority of cementless fixation with respect to cemented total knee arthroplasties in terms of clinical outcomes and survival rates of the implants

Is the femoral intramedullary alignment already actual in total knee arthroplasty?

Abstract Clinical outcomes and overall alignment after total knee arthroplasty (TKA) depend on femoral component positioning in the sagittal and the coronal plane, making choice of the distal femoral cutting guide crucial. Currently, there is no consensus on the potential advantage of an extramedullary (EM) guide compared to an intramedullary (IM) guide in TKA. The IM guide is the most widely used system for making the distal femoral cut although evidence for its superiority over the EM guide is lacking. However, inaccuracies arising with the IM guide include location of the rod entry point in the coronal plane, femoral canal diameter, femoral bowing, and structural features of the rod. Furthermore, the invasive procedure is associated with increased risk of postoperative blood loss, thromboembolic complications, and intraoperative fractures. While the EM guide has no such difficulties, its accuracy depends on the instruments used. Studies have reported results not inferior to the IM guide and a lower number of postoperative complications. Patient‐specific instrumentation (PSI) and robotic and computer‐assisted TKA have achieved excellent clinical and radiographic results and can overcome the problems inherent to the IM and the EM guide. Authors performed a systematic review of the literature and proposed a narrative review to summarize the characteristics of the IM and the EM guide and compare the advantages and disadvantages of each, as well as their limitations in comparison with new technologies. Authors also expressed their expert opinion