Meta-Analysis
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2017; 8(2): 192-207
Published online Feb 18, 2017. doi: 10.5312/wjo.v8.i2.192
Total hip replacement: A meta-analysis to evaluate survival of cemented, cementless and hybrid implants
Phedy Phedy, H Dilogo Ismail, Charles Hoo, Yoshi P Djaja
Phedy Phedy, Departement of Orthopaedic and Traumatology, Fatmawati General Hospital, Faculty of Medicine Universities Indonesia, Jakarta 12430, Indonesia
H Dilogo Ismail, Charles Hoo, Yoshi P Djaja, Departement of Orthopaedic and Traumatology, Ciptomangunkusumo General Hospital, Faculty of Medicine Universities Indonesia, Jakarta 10430, Indonesia
Author contributions: All the authors contributed to the manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Data sharing statement: No data were created no data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Phedy Phedy, MD, Spine Consultant, Department of Orthopaedic and Traumatology, Fatmawati General Hospital, Jakarta 12430, Indonesia. phedy.phe@gmail.com
Telephone: +62-813-14010190
Received: September 3, 2016
Peer-review started: September 7, 2016
First decision: September 29, 2016
Revised: October 16, 2016
Accepted: December 7, 2016
Article in press: December 9, 2016
Published online: February 18, 2017
Abstract
AIM

To determine whether cemented, cementless, or hybrid implant was superior to the other in terms of survival rate.

METHODS

Systematic searches across MEDLINE, CINAHL, and Cochrane that compared cemented, cementless and hybrid total hip replacement (THR) were performed. Two independent reviewers evaluated the risk ratios of revision due to any cause, aseptic loosening, infection, and dislocation rate of each implants with a pre-determined form. The risk ratios were pooled separately for clinical trials, cohorts and registers before pooled altogether using fixed-effect model. Meta-regressions were performed to identify the source of heterogeneity. Funnel plots were analyzed.

RESULTS

Twenty-seven studies comprising 5 clinical trials, 9 cohorts, and 13 registers fulfilled the research criteria and analyzed. Compared to cementless THR, cemented THR have pooled RR of 0.47 (95%CI: 0.45-0.48), 0.9 (0.84-0.95), 1.29 (1.06-1.57) and 0.69 (0.6-0.79) for revision due to any reason, revision due to aseptic loosening, revision due to infection, and dislocation respectively. Compared to hybrid THR, the pooled RRs of cemented THR were 0.82 (0.76-0.89), 2.65 (1.14-6.17), 0.98 (0.7-1.38), and 0.67 (0.57-0.79) respectively. Compared to hybrid THR, cementless THR had RRs of 0.7 (0.65-0.75), 0.85 (0.49-1.5), 1.47 (0.93-2.34) and 1.13 (0.98-1.3).

CONCLUSION

Despite the limitations in this study, there was some tendency that cemented fixation was still superior than other types of fixation in terms of implant survival.

Keywords: Total hip replacement, Implant survival, Cemented, Cementless, Hybrid, Meta-analysis

Core tip: To determine whether cemented, cementless, or hybrid implant was superior to the other in terms of survival rate, a meta-analysis of 27 studies, comprising 5 clinical trials, 9 cohorts, and 13 registers, were performed to evaluate the risk ratios of revision due to any cause, aseptic loosening, infection, and dislocation rate. The risk ratios were pooled separately for clinical trials, cohorts and registers before pooled altogether using fixed-effect model. Meta-regressions were performed to identify the source of heterogeneity. Despite the limitations in this study, there was some tendency that cemented fixation was still superior than other types of fixation in terms of implant survival.