Cargando…

Choice of implant combinations in total hip replacement: systematic review and network meta-analysis

Objective To compare the survival of different implant combinations for primary total hip replacement (THR). Design Systematic review and network meta-analysis. Data sources Medline, Embase, The Cochrane Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and the EU Cli...

Descripción completa

Detalles Bibliográficos
Autores principales: López-López, José A, Humphriss, Rachel L, Beswick, Andrew D, Thom, Howard H Z, Hunt, Linda P, Burston, Amanda, Fawsitt, Christopher G, Hollingworth, William, Higgins, Julian P T, Welton, Nicky J, Blom, Ashley W, Marques, Elsa M R
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683044/
https://www.ncbi.nlm.nih.gov/pubmed/29097396
http://dx.doi.org/10.1136/bmj.j4651
_version_ 1783278208633798656
author López-López, José A
Humphriss, Rachel L
Beswick, Andrew D
Thom, Howard H Z
Hunt, Linda P
Burston, Amanda
Fawsitt, Christopher G
Hollingworth, William
Higgins, Julian P T
Welton, Nicky J
Blom, Ashley W
Marques, Elsa M R
author_facet López-López, José A
Humphriss, Rachel L
Beswick, Andrew D
Thom, Howard H Z
Hunt, Linda P
Burston, Amanda
Fawsitt, Christopher G
Hollingworth, William
Higgins, Julian P T
Welton, Nicky J
Blom, Ashley W
Marques, Elsa M R
author_sort López-López, José A
collection PubMed
description Objective To compare the survival of different implant combinations for primary total hip replacement (THR). Design Systematic review and network meta-analysis. Data sources Medline, Embase, The Cochrane Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and the EU Clinical Trials Register. Review methods Published randomised controlled trials comparing different implant combinations. Implant combinations were defined by bearing surface materials (metal-on-polyethylene, ceramic-on-polyethylene, ceramic-on-ceramic, or metal-on-metal), head size (large ≥36 mm or small <36 mm), and fixation technique (cemented, uncemented, hybrid, or reverse hybrid). Our reference implant combination was metal-on-polyethylene (not highly cross linked), small head, and cemented. The primary outcome was revision surgery at 0-2 years and 2-10 years after primary THR. The secondary outcome was the Harris hip score reported by clinicians. Results 77 studies were included in the systematic review, and 15 studies (3177 hips) in the network meta-analysis for revision. There was no evidence that the risk of revision surgery was reduced by other implant combinations compared with the reference implant combination. Although estimates are imprecise, metal-on-metal, small head, cemented implants (hazard ratio 4.4, 95% credible interval 1.6 to 16.6) and resurfacing (12.1, 2.1 to 120.3) increase the risk of revision at 0-2 years after primary THR compared with the reference implant combination. Similar results were observed for the 2-10 years period. 31 studies (2888 patients) were included in the analysis of Harris hip score. No implant combination had a better score than the reference implant combination. Conclusions Newer implant combinations were not found to be better than the reference implant combination (metal-on-polyethylene (not highly cross linked), small head, cemented) in terms of risk of revision surgery or Harris hip score. Metal-on-metal, small head, cemented implants and resurfacing increased the risk of revision surgery compared with the reference implant combination. The results were consistent with observational evidence and were replicated in sensitivity analysis but were limited by poor reporting across studies. Systematic review registration PROSPERO CRD42015019435.
format Online
Article
Text
id pubmed-5683044
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher BMJ Publishing Group Ltd.
record_format MEDLINE/PubMed
spelling pubmed-56830442017-11-17 Choice of implant combinations in total hip replacement: systematic review and network meta-analysis López-López, José A Humphriss, Rachel L Beswick, Andrew D Thom, Howard H Z Hunt, Linda P Burston, Amanda Fawsitt, Christopher G Hollingworth, William Higgins, Julian P T Welton, Nicky J Blom, Ashley W Marques, Elsa M R BMJ Research Objective To compare the survival of different implant combinations for primary total hip replacement (THR). Design Systematic review and network meta-analysis. Data sources Medline, Embase, The Cochrane Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and the EU Clinical Trials Register. Review methods Published randomised controlled trials comparing different implant combinations. Implant combinations were defined by bearing surface materials (metal-on-polyethylene, ceramic-on-polyethylene, ceramic-on-ceramic, or metal-on-metal), head size (large ≥36 mm or small <36 mm), and fixation technique (cemented, uncemented, hybrid, or reverse hybrid). Our reference implant combination was metal-on-polyethylene (not highly cross linked), small head, and cemented. The primary outcome was revision surgery at 0-2 years and 2-10 years after primary THR. The secondary outcome was the Harris hip score reported by clinicians. Results 77 studies were included in the systematic review, and 15 studies (3177 hips) in the network meta-analysis for revision. There was no evidence that the risk of revision surgery was reduced by other implant combinations compared with the reference implant combination. Although estimates are imprecise, metal-on-metal, small head, cemented implants (hazard ratio 4.4, 95% credible interval 1.6 to 16.6) and resurfacing (12.1, 2.1 to 120.3) increase the risk of revision at 0-2 years after primary THR compared with the reference implant combination. Similar results were observed for the 2-10 years period. 31 studies (2888 patients) were included in the analysis of Harris hip score. No implant combination had a better score than the reference implant combination. Conclusions Newer implant combinations were not found to be better than the reference implant combination (metal-on-polyethylene (not highly cross linked), small head, cemented) in terms of risk of revision surgery or Harris hip score. Metal-on-metal, small head, cemented implants and resurfacing increased the risk of revision surgery compared with the reference implant combination. The results were consistent with observational evidence and were replicated in sensitivity analysis but were limited by poor reporting across studies. Systematic review registration PROSPERO CRD42015019435. BMJ Publishing Group Ltd. 2017-10-31 /pmc/articles/PMC5683044/ /pubmed/29097396 http://dx.doi.org/10.1136/bmj.j4651 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/.
spellingShingle Research
López-López, José A
Humphriss, Rachel L
Beswick, Andrew D
Thom, Howard H Z
Hunt, Linda P
Burston, Amanda
Fawsitt, Christopher G
Hollingworth, William
Higgins, Julian P T
Welton, Nicky J
Blom, Ashley W
Marques, Elsa M R
Choice of implant combinations in total hip replacement: systematic review and network meta-analysis
title Choice of implant combinations in total hip replacement: systematic review and network meta-analysis
title_full Choice of implant combinations in total hip replacement: systematic review and network meta-analysis
title_fullStr Choice of implant combinations in total hip replacement: systematic review and network meta-analysis
title_full_unstemmed Choice of implant combinations in total hip replacement: systematic review and network meta-analysis
title_short Choice of implant combinations in total hip replacement: systematic review and network meta-analysis
title_sort choice of implant combinations in total hip replacement: systematic review and network meta-analysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683044/
https://www.ncbi.nlm.nih.gov/pubmed/29097396
http://dx.doi.org/10.1136/bmj.j4651
work_keys_str_mv AT lopezlopezjosea choiceofimplantcombinationsintotalhipreplacementsystematicreviewandnetworkmetaanalysis
AT humphrissrachell choiceofimplantcombinationsintotalhipreplacementsystematicreviewandnetworkmetaanalysis
AT beswickandrewd choiceofimplantcombinationsintotalhipreplacementsystematicreviewandnetworkmetaanalysis
AT thomhowardhz choiceofimplantcombinationsintotalhipreplacementsystematicreviewandnetworkmetaanalysis
AT huntlindap choiceofimplantcombinationsintotalhipreplacementsystematicreviewandnetworkmetaanalysis
AT burstonamanda choiceofimplantcombinationsintotalhipreplacementsystematicreviewandnetworkmetaanalysis
AT fawsittchristopherg choiceofimplantcombinationsintotalhipreplacementsystematicreviewandnetworkmetaanalysis
AT hollingworthwilliam choiceofimplantcombinationsintotalhipreplacementsystematicreviewandnetworkmetaanalysis
AT higginsjulianpt choiceofimplantcombinationsintotalhipreplacementsystematicreviewandnetworkmetaanalysis
AT weltonnickyj choiceofimplantcombinationsintotalhipreplacementsystematicreviewandnetworkmetaanalysis
AT blomashleyw choiceofimplantcombinationsintotalhipreplacementsystematicreviewandnetworkmetaanalysis
AT marqueselsamr choiceofimplantcombinationsintotalhipreplacementsystematicreviewandnetworkmetaanalysis