Ergebnisse nach minimalinvasivem Knieersatz – eine Metaanalyse

Zusammenfassung

Studienziel: Eine Metaanalyse randomisierter, kontrollierter Studien zum minimalinvasiven totalen Knieersatz im Vergleich zur Standardoperation. Methode: Online-Datenbanken (Medline, EMBASE, CINAHL, CCTR) und Kongressbände wurden nach prospektiven, randomisierten, kontrollierten Studien durchsucht, die minimalinvasive Knieendoprothetik mit dem Standardprozedere vergleichen. Daten bezüglich Schmerz, Funktion, gemessen mittels Scores sowie Komplikationsrate und Implantatposition, wurden extrahiert und gesammelt. Random-Effects- und Fixed-Effects-Modelle wurden angewandt, um diese Daten zu poolen. Ergebnisse: Es zeigte sich eine gewichtete mittlere Differenz von 1,4 (95 %-KI 1,8 bis 1,0, p = 0,014) VAS-Punkten für Schmerz zugunsten MIS, sowie eine standardisierte mittlere Differenz von 0,6 (95 %-KI 0,03 bis 1,12, p = 0,038) für die Funktionsscores. Für Komplikationsraten zeigte sich keine signifikante Differenz (OR 1,3, 95 %-KI 0,6 bis 2,9, p = 0,477). Es zeigten sich weder ein Unterschied in Implantatposition noch ein Einfluss von Navigation auf die Endpunkte. Schlussfolgerung: Der minimalinvasive Knieersatz zeigt postoperativ signifikant weniger Schmerz und eine bessere Funktion, bei gleicher Komplikationsrate und Implantatposition.

Abstract

Aim: A systematic review of randomised controlled trials reporting on the comparison of minimally invasive total knee replacement and standard incision technique was carried out. Method: Online searches were performed in Medline, CINAHL, EMBASE, and the Cochrane Controlled Trials Register. Data concerning the endpoints postoperative pain, function, complications, and implant position were extracted in duplicate and pooled using fixed and random effects models. Results: Weighted mean differences for postoperative pain showed 1.4 (95 % CI 1.8 to 1.0, p = 0.014) point better results for MIS. For function, standardised mean differences were calculated and showed better results for MIS, too (0.6 points, 95 % CI 0.03 to 1.12, p = 0.038). There were no significant differences in complication rates (OR 1.3, 95 % CI 0.6 to 2.9, p = 0.477) and implant position. Meta-regression showed no influence of navigation on any of the endpoints. Conclusion: Minimally invasive total knee replacement showed better postoperative pain and function without any differences in complication rates or implant position.

Schlüsselwörter

minimalinvasive Knieprothese - Metaanalyse - evidenzbasierte Medizin

Key words

minimally invasive knee replacement - meta‐analysis - evidence‐based medicine

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