Analysis of various THA interventions for the treatment of end stage arthritis of the hip .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(18):14 PLoS One. 2014 Jul 8;9(7):e99804Results from 14 RCTs and 5 systematic reviews were reviewed and pooled to determine the effect various THA interventions had on the pain, disability, and function experienced by patients with end stage arthritis of the hip. Results from the analysis indicated that patients experienced significant postoperative THA improvements in Harris Hip scores between 6 months and 10 years, but that improvements did not differ between various impact types. Additionally, a reduced risk of implant dislocation following intervention was noted for patients treated with a larger femoral head size or cemented cups (compared to smaller femoral heads and cementless cups, respectively). Those who received cross linked cup liners experienced reduced femoral head penetration and revision when compared to conventional polyethylene liners. Analysis of femoral stem fixation methods and cup shell designs indicated that neither had a significant effect on implant survival rates.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
How would you rate the scientific quality of this evidence?
Ja = 1
Ungewiss = 0.5
Nicht relevant = 0
Nein = 0
Die Bewertung der Berichtskriterien bewertet die Transparenz, mit der die Autoren die methodischen und studienspezifischen Merkmale der Studie in der Veröffentlichung angeben. Die Bewertung ist in fünf Kategorien unterteilt, die im Folgenden vorgestellt werden.
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Introduction
4/4
Accessing Data
4/4
Analysing Data
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Results
3/4
Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Der Fragilitätsindex ist ein Instrument, das bei der Interpretation signifikanter Ergebnisse hilft und ein Maß für die Stärke eines Ergebnisses liefert. Der Fragilitätsindex gibt die Anzahl der aufeinanderfolgenden Ereignisse an, die zu einem dichotomen Ergebnis hinzugefügt werden müssen, damit das Ergebnis nicht mehr signifikant ist. Eine kleine Zahl steht für ein schwächeres Ergebnis und eine große Zahl für ein stärkeres Ergebnis.
Warum wurde diese Studie jetzt benötigt?
The enhancement of designs, fixation methods, sizes, and bearing surfaces of implants for total hip arthroplasty (THA) has produced substantial procedural options for healthcare professionals and orthopaedic surgeons. This variety of potential approaches to TKA warrants an investigation to determine the most optional combinations of THR implants and techniques. The goal of this this systematic review and meta-analysis was to evaluate the clinical effectiveness of different types of THA used for the treatment of end stage arthritis, and to attempt to determine which techniques/ interventions are the most effective.
Was war die wichtigste Forschungsfrage?
How effective are various THA interventions at improving the pain and disability experienced by patients with end stage arthritis of the hip?
- Searches by the authors identified 1,523 unique records, of which, 14 RCTs and 5 systematic reviews were included.
- 7 studies reported mean postoperative Harris Hip score between 6 months and 10 years. Results across the studies suggested that Harris Hip score improved in all interventions, but did not improve by significantly greater amounts when comparing patients treated with cemented and cementless cup fixation, between XLPE and transitional polyethylene cup liners, cemented and cementless stem fixation, metal on metal and metal on XLPE femoral head articulations, or ceramic on ceramic and metal on XLPE head articulations (p>0.05 for all).
- No differences were apparent between patients treated with XLPE or traditional PE cup liners when comparing WOMAC or Short Form-12 scores (p>0.05).
- A reduced risk of implant dislocation with the use of cemented cups was noticed when comparing its results against cementless cups (OR: 0.34, 95% CI: 0.13 to 0.89). A similar finding was found in favour of larger femoral head sizes (36 mm vs. 28 mm).
- Three RCTs indicated that patients with XLPE cup liners experienced a reduction in femoral head penetration rate and risk of revision (RR: 0.18; 95% CI: 0.04 to 0.78) when compared to those who received conventional PE cup liners.
- Analysis indicated that Femoral stem fixation and cup shell design had no significant effect on implant survival rates (p>0.05)
- Patients who received ceramic on ceramic articulations experienced a reduced risk of osteolysis when compared to those treated with XLPE head articulations
Was sollte ich mir besonders merken?
Results from the systematic review and meta-analysis indicated that patients experienced significant postoperative THA improvements in Harris Hip scores at 6 months to 10 years, but that improvements did not differ between various impact types. A reduced risk of implant dislocation following intervention was noted for patients treated with a larger femoral head size or cemented cups (compared to smaller femoral heads and cementless cups, respectively). Those who received cross linked cup liners experienced reduced femoral head penetration and revision when compared to conventional polyethylene liners. Analysis of femoral stem fixation methods and cup shell designs indicated that neither had a significant effect on implant survival rates.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
The majority of evidence obtained in this systematic review and meta-analysis was inconclusive due to poor reporting, missing data, or uncertain treatment estimates. The findings warrant cautious interpretation given the potential risk of bias, methodological limitations (small sample size, low event counts, short follow-up), and weak reporting of some studies included in this review. Long-term, detailed, RCTs on the topics included in this report are needed for more definitive conclusions.
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