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Abstract
Purpose We performed two parallel systematic reviews and meta-analyses to determine the association between early migration of tibial components and late aseptic revision.
Methods One review comprised early migration data from radiostereometric analysis (RSA) studies, while the other focused on revision rates for aseptic loosening from long-term survival studies. Thresholds for acceptable and unacceptable migration were determined according to that of several national joint registries: < 5% revision at 10 years.
Results Following an elaborate literature search, 50 studies (involving 847 total knee prostheses (TKPs)) were included in the RSA review and 56 studies (20,599 TKPs) were included in the survival review. The results showed that for every mm increase in migration there was an 8% increase in revision rate, which remained after correction for age, sex, diagnosis, hospital type, continent, and study quality. Consequently, migration up to 0.5 mm was considered acceptable during the first postoperative year, while migration of 1.6 mm or more was unacceptable. TKPs with migration of between 0.5 and 1.6 mm were considered to be at risk of having revision rates higher than 5% at 10 years.
Interpretation There was a clinically relevant association between early migration of TKPs and late revision for loosening. The proposed migration thresholds can be implemented in a phased, evidence-based introduction of new types of knee prostheses, since they allow early detection of high-risk TKPs while exposing only a small number of patients.
RN, BP, and EV had the idea for the study. SM provided methodological input and MF provided statistical input during the conceptual phase of the study. JP designed the search strategy for the literature search. BP and EV performed the study selection and matching procedure. KN and BP appraised the quality of the literature and performed the data extraction. MF and BP analyzed the data. BP, KN, EV, and RN wrote the initial draft manuscript. MF and SM ensured the accuracy of data and analysis. BP and MF wrote the Appendix. Critical revision of the manuscript was performed by all authors. All authors read and approved the final manuscript.
The authors thank the Atlantic Innovation Fund (Atlantic Canada Opportunities Agency) for providing funding for this study (contract no. 191933). The Atlantic Innovation Fund did not take part in the design or conduct of the study; in the collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript.