ARTHROPLASTY
Early proximal migration of cups is associated with late revision in THA: a systematic review and meta-analysis of 26 RSA studies and 49 survivalstudies
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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
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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?
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報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
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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
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
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.
主な研究課題は何ですか？
Does the early migration of the acetabular cup have a specific association with late revision for aseptic loosening?
重要な知見は？
- 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.
最も覚えておくべきことは？
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.
それが私の患者ケアにどのように影響するか？
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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