Abstract
BackgroundEvolvements in the design, fixation methods, size, and bearing surface of implants for total hip replacement (THR) have led to a variety of options for healthcare professionals to consider. The need to determine the most optimal combinations of THR implant is warranted. This systematic review evaluated the clinical effectiveness of different types of THR used for the treatment of end stage arthritis of the hip.MethodsA comprehensive literature search was undertaken in major health databases. Randomised controlled trials (RCTs) and systematic reviews published from 2008 onwards comparing different types of primary THR in patients with end stage arthritis of the hip were included.ResultsFourteen RCTs and five systematic reviews were included. Patients experienced significant post-THR improvements in Harris Hip scores, but this did not differ between impact types. There was a reduced risk of implant dislocation after receiving a larger femoral head size (36 mm vs. 28 mm; RR = 0.17, 95% CI: 0.04, 0.78) or cemented cup (vs. cementless cup; pooled odds ratio: 0.34, 95% CI: 0.13, 0.89). Recipients of cross-linked vs. conventional polyethylene cup liners experienced reduced femoral head penetration and revision. There was no impact of femoral stem fixation and cup shell design on implant survival rates. Evidence on mortality and complications (aseptic loosening, femoral fracture) was inconclusive.ConclusionsThe majority of evidence was inconclusive due to poor reporting, missing data, or uncertainty in treatment estimates. The findings warrant cautious interpretation given the risk of bias (blinding, attrition), methodological limitations (small sample size, low event counts, short follow-up), and poor reporting. Long-term pragmatic RCTs are needed to allow for more definitive conclusions. Authors are encouraged to specify the minimal clinically important difference and power calculation for their primary outcome(s) as well CONSORT, PRISMA and STROBE guidelines to ensure better reporting and more reliable production and assessment of evidence.
Highlights
Over the past few decades, total hip replacement (THR) has been reported as clinically effective in treating pain and disability resulting from late stage arthritis of the hip [1]
THR is indicated for patients who failed to respond to non-surgical management options such as pharmaceutical treatments, selfmanagement, patient education, acupuncture, exercise, physical therapy, or manual therapy [2,3]
Four Randomised controlled trials (RCTs) were represented by multiple publications and the review cites them as Bjorgul 2010 [22], Engh 2012 [26] [This piece of information contains information from a study with multiple publications [69] (See Table S1 in File S1)], Capello 2008 [28] [This piece of information contains information from a study with multiple publications [70] (See Table S1 in File S1)], and Corten 2011 [32]
Summary
Over the past few decades, total hip replacement (THR) has been reported as clinically effective in treating pain and disability resulting from late stage arthritis of the hip [1]. THR is indicated for patients who failed to respond to non-surgical management options such as pharmaceutical treatments (e.g., analgesics, antiinflammatory agents, steroid injections, topical treatments), selfmanagement, patient education, acupuncture, exercise, physical therapy, or manual therapy [2,3]. This procedure involves the replacement of a damaged hip joint with an artificial hip prosthesis consisting of an acetabular cup (with or without shell) a femoral stem, and femoral head. This systematic review evaluated the clinical effectiveness of different types of THR used for the treatment of end stage arthritis of the hip
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