Is there evidence for a superior method of socket fixation in hip arthroplasty? A systematic review
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Total hip arthroplasty has been a very succesful orthopaedic procedure. The optimal fixation method of the acetabular component however, has not yet been defined.
We performed a systematic review using the Medline and Embase databases to find evidence for the superiority of cemented or cementless acetabular components on short- and long-term clinical and radiological parameters. Methodological quality for randomised trials was assessed using the van Tulder checklist, and for the non randomised studies we used the Newcastle-Ottawa quality assessment scale.
Our search strategy revealed 16 randomised controlled trials (RCT) and 19 non RCT studies in which cemented and cementless acetabular components are compared. A best evidence analysis for complications, wear, osteolysis, migration and clinical scores showed no superiority for either cemented or cementless socket in the RCTs. A best evidence analysis for non RCT studies revealed better osteolysis, migration properties and aseptic loosening survival for cementless sockets; however, wear and overall survival favoured the cemented sockets.
We recommend that an orthopaedic surgeon should choose an established cemented or cementless socket for hip replacement based on patient characteristics, knowledge, experience and preference.
KeywordsAseptic Loosening Acetabular Component Randomise Control Trial Study Cementless Fixation Cementless Acetabular Component
Conflict of interest statement
The authors declare that they have no conflict of interest.
- 5.Franklin J, Robertsson O, Gestsson J, Lohmander LS, Ingvarsson T (2003) Revision and complication rates in 654 Exeter total hip replacements, with a maximum follow-up of 20 years. BMC Musculoskelet Disord 25:4–6Google Scholar
- 9.Buckwalter AE, Callaghan JJ, Liu SS, Pedersen DR, Goetz DD, Sullivan PM, Leinen JA, Johnston RC (2006) Results of Charnley total hip arthroplasty with use of improved femoral cementing techniques. A concise follow-up, at a minimum of twenty-five years, of a previous report. J Bone Joint Surg Am 88:1481–5PubMedCrossRefGoogle Scholar
- 10.Ries MD (2008) Review of the evolution of the cementless acetabular cup. Orthopedics 31(12 suppl 2)Google Scholar
- 16.Wells G, Shea B, O’Connell D, Peterson J, Welch V, Tugwell P. (2000) The Newcastle-Ottewa Scale (NOS) for assessing the quality of non-randomised studies in meta-analyses. Proceedings of the 3rd symposium on systematic reviews: beyond the basics. Oxford Centre for Statistics in Medicine, Oxford, EnglandGoogle Scholar
- 24.Rorabeck CH, Bourne RB, Laupacis A, Feeny D, Wong C, Tugwell P, Leslie K, Bullas R (1994) A double-blind study of 250 cases comparing cemented with cementless total hip arthroplasty. Cost-effectiveness and its impact on health-related quality of life. Clin Orthop Relat Res 298:156–164PubMedGoogle Scholar
- 25.Bourne RB, Rorabeck CH, Laupacis A, Feeny D, Wong C, Tugwell P, Leslie K, Bullas R (1994) A randomized clinical trial comparing cemented to cementless total hip replacement in 250 osteoarthritic patients: the impact on health related quality of life and cost effectiveness. Iowa Orthop J 14:108–114PubMedGoogle Scholar
- 52.Vandenbroucke JP (2009) The HRT controversy: observational studies and RCTs fall in line. Lancet 11:373(9671):1233–1235Google Scholar
- 53.Rawlins MD (2008) De Testimonio: on the evidence for decisions about the use of therapeutic interventions. The Harveian Oration 2008. The royal college of physicians. Clin Med 8(6):579–588Google Scholar
- 58.Havelin LI, Fenstad AM, Salomonsson R, Mehnert F, Furnes O, Overgaard O, Pedersen AB, Herberts P, Karrholm J, Garellick G (2009) The Nordic arthroplasty register association. A unique collaboration between 3 national hip arthroplasty registries with 280,201 THRS. Acta Orthop Scand 80:394–401Google Scholar