Does the use of tibial stem extensions reduce the risk of aseptic loosening in obese patients undergoing primary total knee arthroplasty: A systematic review and meta-analysis
Bibliographic record
Abstract
BACKGROUND: ) patients with stemmed (ST) versus non-stemmed (NST) tibial implants in primary total knee arthroplasty (TKA). METHODS: A systematic review and meta-analysis were conducted following PRISMA and MOOSE guidelines. Studies reporting a direct comparison between ST and NST tibial implants in obese patients were included. The primary outcome of interest was revision for aseptic loosening. Outcomes were analysed using meta-analysis of relative risk. Risk of bias assessment was performed using the Newcastle-Ottawa Scale for observational studies and the RoB-2 Cochrane tool for randomised studies. RESULTS: Seven studies met the selection criteria, consisting of four cohort studies and three randomised controlled trials. Mean follow up time for the eligible cohort was 62.6 months. Meta-analysis demonstrated a statistically significant reduction in the risk of aseptic revision in the ST group compared with the NST group (risk ratio 0.25, 95% confidence interval 0.07 to 0.92). After removal of all zero-event studies, the results remained in favour of the ST group (risk ratio 0.15, 95% confidence interval 0.03 to 0.64). CONCLUSIONS: This study found that obese patients undergoing TKA with stemmed tibial implants may have a lower risk of aseptic revision compared with those with non-stemmed tibial implants. However, due to the lack of high-quality literature available, our study is unable to draw a definitive conclusion on this matter. We suggest that this topic should be re-evaluated using higher-quality study methods, particularly national joint registries studies and randomised controlled trials.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.008 | 0.003 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".