Abstract
BackgroundNumerous quantitatively biomechanical studies measuring the fixation stability of femoral stem using micromotions at the bone-implant interfaces in different directions and levels remain inconclusive. This network meta-analysis performed systematically aims to explore the rank probability of micromotions at the bone-implant interfaces based on biomechanical data from studies published.MethodsTwo electronic databases, PubMed/MEDLINE and Embase, were utilized to retrieve biomechanical studies providing the data of micromotions at the bone-stem interfaces. After screening and diluting out, the studies that met inclusion criteria will be utilized for statistical analysis. In order to contrast the stability of commonness and differences of the different parts of the femoral stem, the horizontal and vertical comparison of micromotions at the bone-implant interfaces were conducted using the pooled evaluation indexes including the mean difference (MD) and the surface under the cumulative ranking (SUCRA) curve, while inconsistency analysis, sensitivity analysis, subgroup analyses, and publication bias were performed for the stability evaluation of outcomes.ResultsScreening determined that 20 studies involving a total of 249 samples were deemed viable for inclusion in the network meta-analysis. Tip point registered the highest micromotions of 13 measurement points. In the horizontal level, the arrangements of 4 measurement points at the proximal (P1–P4), middle (P5–P8) and distal part of the stem (P9–P12) were P1 = P2 = P3 = P4, P7 > P8 > P6 = P5 and P10 ≥ P12 = P9 = P11, respectively. In the vertical level, the arrangements of 3 measurement points at the anterior, posterior, medial, and lateral directions was P9 > P5 = P1, P10 > P6 > P2, P11 > P7 > P3, and P12 > P8 > P4, respectively.ConclusionThe network meta-analysis seems to reveal that the distal part of the femoral stem is easier to register higher micromotion, and tip point of femoral stem registers the highest micromotions.
Highlights
Biomechanical tests are usually performed on synthetic or cadaveric specimens to evaluate the fixation stability of orthopedic implants at the hip, shoulder, and radius and for tendon repairs using bone anchoring devices [1,2,3,4,5,6]
The rationale for the measurement micromotion between bone and implant is based on animal studies that demonstrated that excess movement (150 μm or more) can result in the failure of osseous integration of cementless implants [11, 12]
Seventy-four articles were excluded from the selection process after further scanning where 23 articles were irrelevant publications, 21 articles only presenting finite element analysis data, one article that was a review, and 20 articles lacked sufficient data to be feasible for inclusion in the meta-analyses to calculate statistical index
Summary
Biomechanical tests are usually performed on synthetic or cadaveric specimens to evaluate the fixation stability of orthopedic implants at the hip, shoulder, and radius and for tendon repairs using bone anchoring devices [1,2,3,4,5,6]. Though cemented as well as cementless total hip arthroplasty (THA) demonstrated a satisfactory survival rate (90%, 95%, and 97% at 5, 10, and 15 years follow-up, respectively) [8], aseptic loosening of artificial joint, resulting from the absence of primary stability, wear, and periprosthetical osteolysis as a result of the implantspecific bone remodeling, is one of the most common long-term complications in clinical, which limits the prospective efficacy and service life of prostheses [8]. Numerous quantitatively biomechanical studies measuring the fixation stability of femoral stem using micromotions at the bone-implant interfaces in different directions and levels remain inconclusive This network meta-analysis performed systematically aims to explore the rank probability of micromotions at the bone-implant interfaces based on biomechanical data from studies published
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