ArticlePloS one2026
Implant selection at elective aseptic revision of a primary total knee replacement: A scoping review and map of the evidence.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe recent James Lind Alliance (JLA) Priority Setting Partnership (PSP) on 'the problematic knee replacement' highlighted implant selection at revision knee arthroplasty (rTKA) as a 'Top 10' research priority. The aims of this scoping review are to map the evidence for the implants used at first-time elective aseptic rTKA, to identify gaps in the evidence-base, and to provide recommendations for future research.
methodsA scoping review was conducted in accordance with the Arksey and O'Malley framework and the Joanna Briggs Institute Manual for Evidence Synthesis, and reported according to the PRISMA extension for Scoping Reviews. A comprehensive search of MEDLINE, Embase, CINAHL, CDSR, CENTRAL, DARE, HTA, SCI, PROSPERO and KSR Evidence was conducted on 17th August 2026, covering studies published between 2000 and 2026. Annual reports of 17 national joint replacement registries (NJRRs) were also sought. The review was registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/SD49V).
resultsFollowing deduplication, 7,096 research articles and 155 NJRR reports were identified. After applying eligibility criteria, 121 research articles and six NJRR reports were included. Twenty-two studies (18%) had cohorts clearly defined as exclusively comprising first-time elective aseptic rTKA procedures. The evidence consisted mostly of retrospective case series (45/121, 37%) and retrospective comparative studies (41/121, 34%). Most evidence was Level IV (48/121, 40%) or Level III (46/121, 38%) with no Level I evidence identified. Approximately half the studies were from the United States (58/102, 48%). Five studies (4%) reported mean or median follow up ≥10 years. A map of the evidence, tabulated by five key themes, is presented.
conclusionsThere is a lack of high-level comparative evidence to support implant selection at first-time elective aseptic rTKA. Future research should focus on more clinically homogeneous cohorts and compare outcomes associated with cemented versus hybrid/cementless stems, constraint levels, and metaphyseal fixation devices.
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