Do Implant Coatings Improve Clinical Outcomes in Total Knee Arthroplasty? A Systematic Review and Meta-analysis of Randomized and Propensity Score–Matched Studies
R.E.M. Souto, J.M. Hockmuller, J.G.P. Mendes, E.M. Raposo, I.M. Da Palma, J.A.R.M. PereiraObjective:
To compare the clinical outcomes and implant survival of coated versus uncoated implants in total knee arthroplasty (TKA).
Methods:
A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, EMBASE, and Cochrane Central were searched from inception to December 2025. Randomized controlled trials and propensity score–matched studies comparing coated and uncoated TKA were included. Outcomes of interest were implant survival, Knee Society Score (KSS), Oxford Knee Score (OKS), Visual Analog Scale for pain (VAS), University of California Los Angeles (UCLA) activity score, and SF-36 physical and mental component scores. A random-effects model was used.
Results:
Eight studies comprising 707 patients (345 coated TKAs) were included, with follow-up ranging from 1 to 10 years. At 1-year follow-up, no significant differences were observed between groups for KSS (p=0,41), OKS (p=0,55), VAS (p=0,81), UCLA score (p=0,48), or SF-36 physical (p=0,95) and mental (p=0,58) component scores. At 5 years, uncoated implants demonstrated a statistically higher OKS (p<0,05); however, this difference did not reach the minimal clinically important difference. Implant survival did not differ significantly between coated and uncoated TKAs (p=0,42).
Conclusion:
Coated total knee arthroplasty is not inferior to uncoated implants with respect to clinical outcomes and implant survival at short- and mid-term follow-up.