A systematic review and meta-analysis of hybrid vs. cemented stems - which method is more optimal for revision total knee arthroplasty?

INTRODUCTION: The number of primary and revision Total Knee Arthroplasty (TKA) cases are expected to increase in future. There are various advantages and disadvantage to employing either of the two main types of stem fixation methods - cemented or hybrid technique. This review aimed to study the most optimal fixation method for revision TKAs by comparing radiological outcomes and re-revision rates.

METHODS: A systematic review and meta-analysis was performed using PubMed and Cochrane Library from 2010 to identify studies explicitly comparing outcomes between cemented against hybrid fixation revision TKA techniques, with a minimum follow up of at least 24 months. A total of 8 studies was included in this review. Egger's test and visual inspection of the funnel plot did not reveal publication bias.

RESULTS: There was no statistically significant difference in radiological failure and loosening (OR 0.79, CI 0.37-1.66, I2  = 29%, p = 0.22), all causes of re-revision (OR 1.03, CI 0.73-1.44, I2  = 0%, p = 0.56) and aseptic revision (OR 0.74, CI 0.27-2.02, I2  = 0%, p = 0.41) between cemented and hybrid techniques. Functional and pain outcomes compared between the two fixation techniques were largely similar across the studies included in this meta-analysis.

CONCLUSION: Despite a trend favouring hybrid stems in revision TKA, current evidence revealed that radiological outcomes and re-revision rates are largely similar between cemented and hybrid fixation techniques.