Medial pivot prosthesis has a better functional score and lower complication rate than posterior-stabilized prosthesis: a systematic review and meta-analysis

PURPOSE: We aimed to compare the postoperative clinical efficacy and safety of medial pivot (MP) prosthesis and posterior-stabilized (PS) prosthesis in the treatment of knee osteoarthritis (KOA). METHODS: All studies involving MP and PS prosthesis in PubMed, EMBASE, Cochrane Library, and Web of Science were searched since the establishment of the database. The included outcomes were knee range of motion (ROM), functional score, radiographic results, complication rate, and revision rate. Studies were independently evaluated by the Newcastle–Ottawa Scale for case–control studies and the assessment tool of the Cochrane Collaboration for randomized controlled trials. I(2) was used to test the heterogeneity, and fixed- or random-effects models were selected for meta-analysis according to the heterogeneity results. RESULTS: A total of 19 studies, consisting of 3592 patients and 3783 knees (MP: 1811 knees, PS: 1972 knees), were included in the meta-analysis. The WOMAC (MD = − 1.11, 95% CI − 1.98 to − 0.23; P = 0.01) and HSS (MD = − 4.32, 95% CI − 8.30 to − 0.34; P = 0.03) in the MP group were significantly lower compared with the PS group, and the complication rate (OR 0.53, 95% CI 0.33–0.87; P = 0.01) was also lower compared with the PS group. There was no significant difference in ROM, radiographic results, and revision rate between the two groups (P > 0.5). CONCLUSIONS: The existing literature provided evidence to support better clinical effect and lower complication rate of MP prosthesis compared to PS prosthesis. These results provide a reference for clinicians when choosing a suitable prosthesis.