Are short-stem prostheses superior to conventional stem prostheses in primary total hip arthroplasty? A systematic review and meta-analysis of randomised controlled trials

ObjectiveCementless total hip arthroplasty (THA) is associated with reliable clinical results and high patient satisfaction. Short-stem prostheses (SS) were designed to achieve superior preservation of proximal bone stock and stability compared with those of conventional-stem prostheses (CS). This m...

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Published in:BMJ open 2018-09, Vol.8 (9), p.e021649-e021649
Main Authors: Liang, Hao-Dong, Yang, Wei-Yi, Pan, Jian-Ke, Huang, He-Tao, Luo, Ming-Hui, Zeng, Ling-Feng, Liu, Jun
Format: Article
Language:English
Subjects:
Arthritis
Bone density
Clinical outcomes
Clinical trials
Collaboration
Joint replacement surgery
Joint surgery
Meta-analysis
Patient satisfaction
Prostheses
Surgery
Systematic review
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creator Liang, Hao-Dong
Yang, Wei-Yi
Pan, Jian-Ke
Huang, He-Tao
Luo, Ming-Hui
Zeng, Ling-Feng
Liu, Jun
description ObjectiveCementless total hip arthroplasty (THA) is associated with reliable clinical results and high patient satisfaction. Short-stem prostheses (SS) were designed to achieve superior preservation of proximal bone stock and stability compared with those of conventional-stem prostheses (CS). This meta-analysis was conducted to determine the proximal bone remodelling, revision rate, Harris Hip Score, radiolucent line and maximum total point motion values of both SS and CS for primary THA.MethodRelevant randomised controlled trials (RCTs) involving SS and CS in primary THA were identified from electronic databases, such as EMBASE, PubMed and the Cochrane Library.ResultUltimately, 12 RCTs involving 1130 patients (1387 hips) were included. The results showed that compared with CS, SS resulted in less bone mineral density (BMD) changes in Gruen zone 7 at 1 year and 2 years postoperatively (mean difference (MD)=5.11; 95% CI, 1.61, 8.61; P=0.30; and MD=4.90; 95% CI, 1.01, 8.79; P=0.17, respectively). No difference in BMD changes was found for Gruen zone 1 (MD=2.66; 95% CI, −3.31, 8.64; P
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A systematic review and meta-analysis of randomised controlled trials</title><source>PubMed (Medline)</source><source>BMJ journals single titles</source><source>Publicly Available Content (ProQuest)</source><source>British Medical Journal Open Access Journals</source><creator>Liang, Hao-Dong ; Yang, Wei-Yi ; Pan, Jian-Ke ; Huang, He-Tao ; Luo, Ming-Hui ; Zeng, Ling-Feng ; Liu, Jun</creator><creatorcontrib>Liang, Hao-Dong ; Yang, Wei-Yi ; Pan, Jian-Ke ; Huang, He-Tao ; Luo, Ming-Hui ; Zeng, Ling-Feng ; Liu, Jun</creatorcontrib><description>ObjectiveCementless total hip arthroplasty (THA) is associated with reliable clinical results and high patient satisfaction. Short-stem prostheses (SS) were designed to achieve superior preservation of proximal bone stock and stability compared with those of conventional-stem prostheses (CS). This meta-analysis was conducted to determine the proximal bone remodelling, revision rate, Harris Hip Score, radiolucent line and maximum total point motion values of both SS and CS for primary THA.MethodRelevant randomised controlled trials (RCTs) involving SS and CS in primary THA were identified from electronic databases, such as EMBASE, PubMed and the Cochrane Library.ResultUltimately, 12 RCTs involving 1130 patients (1387 hips) were included. The results showed that compared with CS, SS resulted in less bone mineral density (BMD) changes in Gruen zone 7 at 1 year and 2 years postoperatively (mean difference (MD)=5.11; 95% CI, 1.61, 8.61; P=0.30; and MD=4.90; 95% CI, 1.01, 8.79; P=0.17, respectively). No difference in BMD changes was found for Gruen zone 1 (MD=2.66; 95% CI, −3.31, 8.64; P&lt;0.00001), and no differences were observed for the revision rate (relative risk (RR)=1.52; 95% CI, 0.71, 3.26; P=0.94), Harris Hip Score (MD=−0.38; 95% CI, −1.02, 0.26; P=0.89) or stem migration (MD=0.02; 95% CI, −0.07, 0.11; P=0.04).ConclusionOur results suggest that compared with CS, SS may provide superior bone remodelling and similar survival rates and clinical outcomes. However, the short-term follow-up of the included studies was inadequate to determine the long-term performance of SS.</description><identifier>ISSN: 2044-6055</identifier><identifier>EISSN: 2044-6055</identifier><identifier>DOI: 10.1136/bmjopen-2018-021649</identifier><identifier>PMID: 30244208</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Arthritis ; Bone density ; Clinical outcomes ; Clinical trials ; Collaboration ; Joint replacement surgery ; Joint surgery ; Meta-analysis ; Patient satisfaction ; Prostheses ; Surgery ; Systematic review</subject><ispartof>BMJ open, 2018-09, Vol.8 (9), p.e021649-e021649</ispartof><rights>Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2018 Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article 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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b472t-81d8c02173e2b984a5b34da6e8cabe37cb732ee7f471f2fcc83e2d1f624ada7d3</citedby><cites>FETCH-LOGICAL-b472t-81d8c02173e2b984a5b34da6e8cabe37cb732ee7f471f2fcc83e2d1f624ada7d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2663984307/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2663984307?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>112,113,230,314,727,780,784,885,3194,25753,27549,27550,27924,27925,37012,37013,44590,53791,53793,75126,77594,77595,77601,77632</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30244208$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Liang, Hao-Dong</creatorcontrib><creatorcontrib>Yang, Wei-Yi</creatorcontrib><creatorcontrib>Pan, Jian-Ke</creatorcontrib><creatorcontrib>Huang, He-Tao</creatorcontrib><creatorcontrib>Luo, Ming-Hui</creatorcontrib><creatorcontrib>Zeng, Ling-Feng</creatorcontrib><creatorcontrib>Liu, Jun</creatorcontrib><title>Are short-stem prostheses superior to conventional stem prostheses in primary total hip arthroplasty? A systematic review and meta-analysis of randomised controlled trials</title><title>BMJ open</title><addtitle>BMJ Open</addtitle><description>ObjectiveCementless total hip arthroplasty (THA) is associated with reliable clinical results and high patient satisfaction. Short-stem prostheses (SS) were designed to achieve superior preservation of proximal bone stock and stability compared with those of conventional-stem prostheses (CS). This meta-analysis was conducted to determine the proximal bone remodelling, revision rate, Harris Hip Score, radiolucent line and maximum total point motion values of both SS and CS for primary THA.MethodRelevant randomised controlled trials (RCTs) involving SS and CS in primary THA were identified from electronic databases, such as EMBASE, PubMed and the Cochrane Library.ResultUltimately, 12 RCTs involving 1130 patients (1387 hips) were included. The results showed that compared with CS, SS resulted in less bone mineral density (BMD) changes in Gruen zone 7 at 1 year and 2 years postoperatively (mean difference (MD)=5.11; 95% CI, 1.61, 8.61; P=0.30; and MD=4.90; 95% CI, 1.01, 8.79; P=0.17, respectively). No difference in BMD changes was found for Gruen zone 1 (MD=2.66; 95% CI, −3.31, 8.64; P&lt;0.00001), and no differences were observed for the revision rate (relative risk (RR)=1.52; 95% CI, 0.71, 3.26; P=0.94), Harris Hip Score (MD=−0.38; 95% CI, −1.02, 0.26; P=0.89) or stem migration (MD=0.02; 95% CI, −0.07, 0.11; P=0.04).ConclusionOur results suggest that compared with CS, SS may provide superior bone remodelling and similar survival rates and clinical outcomes. 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A systematic review and meta-analysis of randomised controlled trials</atitle><jtitle>BMJ open</jtitle><addtitle>BMJ Open</addtitle><date>2018-09-21</date><risdate>2018</risdate><volume>8</volume><issue>9</issue><spage>e021649</spage><epage>e021649</epage><pages>e021649-e021649</pages><issn>2044-6055</issn><eissn>2044-6055</eissn><abstract>ObjectiveCementless total hip arthroplasty (THA) is associated with reliable clinical results and high patient satisfaction. Short-stem prostheses (SS) were designed to achieve superior preservation of proximal bone stock and stability compared with those of conventional-stem prostheses (CS). This meta-analysis was conducted to determine the proximal bone remodelling, revision rate, Harris Hip Score, radiolucent line and maximum total point motion values of both SS and CS for primary THA.MethodRelevant randomised controlled trials (RCTs) involving SS and CS in primary THA were identified from electronic databases, such as EMBASE, PubMed and the Cochrane Library.ResultUltimately, 12 RCTs involving 1130 patients (1387 hips) were included. The results showed that compared with CS, SS resulted in less bone mineral density (BMD) changes in Gruen zone 7 at 1 year and 2 years postoperatively (mean difference (MD)=5.11; 95% CI, 1.61, 8.61; P=0.30; and MD=4.90; 95% CI, 1.01, 8.79; P=0.17, respectively). No difference in BMD changes was found for Gruen zone 1 (MD=2.66; 95% CI, −3.31, 8.64; P&lt;0.00001), and no differences were observed for the revision rate (relative risk (RR)=1.52; 95% CI, 0.71, 3.26; P=0.94), Harris Hip Score (MD=−0.38; 95% CI, −1.02, 0.26; P=0.89) or stem migration (MD=0.02; 95% CI, −0.07, 0.11; P=0.04).ConclusionOur results suggest that compared with CS, SS may provide superior bone remodelling and similar survival rates and clinical outcomes. However, the short-term follow-up of the included studies was inadequate to determine the long-term performance of SS.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>30244208</pmid><doi>10.1136/bmjopen-2018-021649</doi><oa>free_for_read</oa></addata></record>
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source PubMed (Medline); BMJ journals single titles; Publicly Available Content (ProQuest); British Medical Journal Open Access Journals
subjects Arthritis
Bone density
Clinical outcomes
Clinical trials
Collaboration
Joint replacement surgery
Joint surgery
Meta-analysis
Patient satisfaction
Prostheses
Surgery
Systematic review
title Are short-stem prostheses superior to conventional stem prostheses in primary total hip arthroplasty? A systematic review and meta-analysis of randomised controlled trials
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