Tsertsvadze, Alexander, Grove, Amy L., Freeman, Karoline, Court, Rachel A., Johnson, Samantha Ann, Connock, M., Clarke, Aileen and Sutcliffe, P. (Paul) (2014) Total hip replacement for the treatment of end stage arthritis of the hip : a systematic review and meta-analysis. PLoS One, Volume 9 (Number 7). Article number e99804. doi:10.1371/journal.pone.0099804

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Abstract

Background: Evolvements 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.

Methods: A 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.

Results: Fourteen 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.

Conclusions: The 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.

Item Type:	Journal Article
Subjects:	R Medicine > RD Surgery
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences Administration > Library Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Total hip replacement, Arthritis -- Surgery
Journal or Publication Title:	PLoS One
Publisher:	Public Library of Science
ISSN:	1932-6203
Official Date:	8 July 2014
Dates:	Date Event 8 July 2014 Published 19 May 2014 Accepted 3 February 2014 Submitted
Volume:	Volume 9
Number:	Number 7
Article Number:	Article number e99804
DOI:	10.1371/journal.pone.0099804
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
Funder:	NIHR Health Technology Assessment Programme (Great Britain), National Institute for Health Research (Great Britain) (NIHR)
Grant number:	11/118 (HTA), DRF-2013-06-064 (NIHR)

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