Total Hip Arthroplasty In Patients With Advanced Osteonecrosis Of The Femoral Head:a Systems Review Of Cemented And Biological Prosthesis

Background: Whether cemented prosthesis is performed during total hipreplacement or cementless has been controversial.Objective: System evaluation of total hip replacement in the treatment of thedifferent effects of the prosthesis in avascular necrosis process, to provide a theoreticalreference for further clinical research.Methods: We identified eligible studies in Cochrane Central Register ofControlled Trials（2013.01）, PubMed（1966-2013.01）,EMBASE（1966-2013.01）,OVIDMEDLINE(1978-2013.01),CBM(1978-2013.01),CNKI(1980-2013.01),VIP(1989-2013.01),and handsearched some Chinese orthopedic journal（s2012.01-2013.01）.Metaanalysis uses the Revman5.0.25software provided by Cochrane collaboration.Theheterogeneity of pilot test among researehes is used by the chi-square test.Thefixed-effect model analysis was adopted in case of absence of heterogeneity(P>0.05),otherwise the sources of heterogeneity were analyzed,and random effectmodel adopted in accordance with the aetual situation,even use sub-group analysis orabandon Meta-analysis,in stead of descriptive analysis only.If the research datacollected is impossible or inappropriate to carry out Meta analysis,descriptive analysisonly.Results：333hips were included in the4published studies, including145hips inthe cemented group and188in the uncemented group. The result of the meta-analysisindicated that prosthesis revision rate [RR=1.97,95%CI (0.99,3.89)], postoperativecomplications [RR=1.49,95%CI (0.45,4.93)], surgeryafter Harris scores [WMD=1.87,95%CI (-1.06,4.79)] were similar between the cemented group and the cementlessgroup in THA. In addition, complications subgroup analysis showed, the incidence ofpostoperative infections [RR=3.00,95%CI (0.51,17.79)], and the incidence of postoperative dislocation rate [RR=1.12,95%CI (0.28,4.52)] had no statisticssignificance; rate of postoperative loose [RR=3.47,95%CI (1.05,11.43)] andpostoperative thigh pain incidence [RR=0.18,95%CI (0.03,0.98)] are significantdifferences. It was not significant in the Harris scores subgroup analysis.Conclusion: Based on existing clinical data, the cemented group for total hiparthroplasty is as safe and effective as the uncemented group in revision rate, theincidence of complications and postoperative Harris hip score.But in the complicationsubgroup analysis, the high incidence of the cement group is higher than theuncemented group in postoperative incidence loosening,the cement group is belowerthan the uncemented group in the incidence of postoperative thigh pain. There was nostatistically significant difference in the Harris hip score subgroup analysis. However,due to the limitations of the study quality and sample, the conclusion is required largerandomized controlled trials to be rigorously designed.