Fixation Of Femoral Component In Hip Arthroplasty: A Systematic Review

Background Hip arthroplasty is one of the most effective surgical method to treat the pain and dysfunction of the hip joint. The big problems for hip arthroplasty are the well fixation of the prothesis for a long time and the postoperative complications. Cemented fixation or uncemented fixation which one is a better choice is controversial. Furthermore, the best proofs are needed to help orthopaedists to determine an appropriate fixation method.Objective It is to evaluate the difference of two fixation methods of femoral component in hip arthroplasty in order to choose a more appropriate fixation method.Methods Search were applied to the following electronic database: Chinese Bio-medicine Database (CBM) (1979-2004.12), MEDLINE (1966-2005.2), EMBASE(1984~2004) and Cochrane Library(Issue 4,2004). We also hand-searched Chinese journal of Orthopaedy , the Journal of Bone and Joint Injury and Orthopaedic journal of China (all are from establishment to Feb 2005). Identified the randomized controlled trials and clinical trials then applied Revman 4.2 for statistical analysis.Results Nine randomized controlled trials and 22 clinical controlled trials involving 3883 hips were included. The evaluated indexes included revision, subsidence, osteolysis, thigh pain, embolization, cortical hypertrophy, limp and heterotopic ossification. The combined results of randomized controlled trials showed that there was heterogeneity for the revision of the femoral component and no statistic difference between the two groups; the subsidence of femoral component [OR 14.50, 95%CI(3.78,55.56), p<0.0001] and the cortical hypertrophy [OR 69.97, 95%CI(27.88,175.57), p<0.0001] were more commonly found in uncemented group; the embolization occurred more commonly in the first and second generation cemented group [OR 0.02, 95%CI(0,0.11),p<0.0001] and difference was not found between the third generation cemented group and the uncemented group. The clinical trials showed that the revision of femoral component was lower in the cemented group(4.2%) than in the uncemented group(7.2%); the subsidence of femur was also lower in the cemented one(1.3%) than in the uncemented group(10.6%); the osteolysis was less commonly found in the cemented group(12%) than in the uncemented group(33.3%); the thigh pain occurrence was lower in the cemented group(6.8%) than in the uncemented group(23.6%); the limp occurrence in the cemented group(28%) was higher than in the uncemented group(22.8%) but no difference was found(p=0.34); the heterotopic ossification in the cemented group(36.8%) was also higher than in the uncemented group(34.2%) but also no difference was found in the two groups(p=0.45). Conclusion Compared with uncemented group, cemented fixation wasless found in revision of femoral component, femoral subsidence, osteolysis, the postoperative thigh pain and femoral cortical hypertrophy. There may be more associated with embolization in the first and second generation cemented technique than in the uncemented group and no difference between the third generation cemented technique group and the uncemented group. Difference was not found in limp and heterotopic ossification between the cemented group and the uncemented group. From the literatures we collected it may conclude that the cemented fixation method had more advantages than the uncemented fixation method, however there still need more long time follow-up period randomized controlled trials and high quality clinical trials to prove it.