Cemented versus uncemented fixation in total hip replacement .
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):28 Acta Orthopaedica 2007; 78 (3): 315–326Use of cemented versus un-cemented implant fixation in total hip arthroplasty (THA) has long been an area of debate. Although cemented components have long had unsurpassed prosthesis survival rate, more and more THAs are being performed with un-cemented components. The current systematic review and meta analysis compared the pros and cons to cemented versus un-cemented fixation to determine which has a better overall performance. The study found that although the performance of un-cemented components is improving, cemented fixation continues to be unparalleled.
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?
Oui = 1
Incertain = 0,5
Non pertinent = 0
Non = 0
L'évaluation des critères de rapport permet d'évaluer la transparence avec laquelle les auteurs rapportent les caractéristiques méthodologiques et les caractéristiques de l'essai dans la publication. L'évaluation est divisée en cinq catégories qui sont présentées ci-dessous.
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Introduction
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Accessing Data
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Analysing Data
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Results
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
L'indice de fragilité est un outil qui aide à l'interprétation des résultats significatifs, en fournissant une mesure de la force d'un résultat. L'indice de fragilité représente le nombre d'événements consécutifs qui doivent être ajoutés à un résultat dichotomique pour que le résultat ne soit plus significatif. Un petit nombre représente un résultat plus faible et un grand nombre un résultat plus fort.
Pourquoi cette étude était-elle nécessaire maintenant ?
Amidst the debate of cement versus un-cemented fixation, a clear answer on survivorship and rate of revisions has not been clearly established. A summary of evidence on how the type of fixation affects rate of survivorship is needed to determine which fixation is superior.
Quelle était la principale question de recherche ?
In THA is survivorship superior with cemented or uncemented fixation?
- No overall superiority was demonstrated when failure was defined as revision of either or both components.
- Cemented fixation had favourable results at the population level but generalizability of this should be considered with caution due to sample differences.
- Further, cemented fixation was found to be inferior when titanium stems were used and superior when a stainless steel or cobalt chrome stem were used.
- Survivorship with un-cemented fixation improved overtime since 1995.
De quoi dois-je me souvenir en priorité ?
The current literature suggests fixation with cement has superior survival rates when compared to un-cemented fixation although un-cemented fixation survivorship has improved over time.
Comment cela affectera-t-il les soins prodigués à mes patients ?
Although un-cemented fixation is improving, cemented fixation continues to outperform un-cemented fixation. However, more research with improved methods are needed to further determine the benefits of each method specific to various populations.
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