THA: Early migration of acetabular cups associated with late revision due to loosening .
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(1):5 Acta Orthop. 2012 Dec;83(6):583-91. doi: 10.3109/17453674.2012.745353. Epub 2012 Nov 5Exclusive Author Interview
Dr. Pijls discussing the association between early migration of acetabular cups and late aseptic revision.
Two parallel systematic reviews and meta-analyses were performed to determine the affiliation between early migration of acetabular cups and late aseptic revision. One review covered the early migration data from radio-stereometric analysis (RSA) studies (26 studies involving 700 cups), and the other focused on revision rates for aseptic loosening from long-term survival studies (49 studies involving 38,013 cups). The results showed that there was a clinically significant association between early migration of acetabular cups and late revision due to loosening; cups with proximal migration of between 0.2 and 1.0 mm were considered to be at risk of having revision rates greater than 5% at 10 years. Furthermore, cups with proximal migration of more than 1.0mm were considered unacceptable, as all of them showed revision rates of more than 5% at 10 years
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
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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
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?
Each year, several hundred thousand total hip arthroplasties (THAs) are performed globally, and this number is expected to double within the next 2 decades. It is critical to monitor the safety and quality of THA to avoid harm and to minimize cost to the community. While it may take 10 years before the final stages of loosening become apparent on conventional radiographs, it is possible to detect loosening early preoperatively with radiostereometric analysis (RSA). Hence, this review hypothesized that early migration of the acetabular cup (measured through RSA) is associated with late revision for aseptic loosening.
Was war die wichtigste Forschungsfrage?
Does the early migration of the acetabular cup have a specific association with late revision for aseptic loosening?
- Clear association was shown between 2-year proximal migration and the 10-year revision rate expressed as prosthesis survival; for every 1 mm increase in proximal migration (at 2 years), 10 % (95% CI: 5.5 – 14.2; p < 0.05) was added to the 10-year revision rate.
- A number of factors were found that may have influenced the association between the 2-year proximal migration and the 10-year revision rate; however, the association remained significant (P < 0.05) following adjustments for these potential confounding factors.
- No clear association was seen between proximal migration rate (i.e. 2-year proximal migration minus 1-year proximal migration) and the 10-year revision rate.
- Results indicated that accepting 5% revision at 10 years resulted in a threshold of 0.2 mm for acceptable proximal migration at 2 years and a threshold of 1.0 mm for unacceptable proximal migration at 2 years.
Was sollte ich mir besonders merken?
Clinically relevant associations between early proximal migration of acetabular cups (measured with RSA) and clinical failure (defined as revision surgery) was shown. Each mm of proximal migration increased the 10-year revision rate by an average of 10%, a rate that is more than double the standard revision rates of several national joint registries.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
There is a clinically relevant association between early migration of the acetabular component of a total hip arthroplasty and late revision for loosening. The proposed migration thresholds can be established in a phased, evidence-based introduction, as they allow early detection of high-risk THAs while exposing a small number of patients.
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