Introduction
Methods
Search strategy
Data extraction
Quality appraisal in relation to research questions
Statistical methods
Results
Search
First author [Ref] | Country | Language | Component | Study design | 1. Study design | 2. Prospective | 3. Uniform implant | 4. Uniform patient population | 5. Selection criteria | 6. Outcome assessment | 7. Sample size | 8. Attrition bias/lost to FU | 9. Statistics | 10. COI | Total score | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Hoikka [42] | Finland | English | Cup and stem | Case series | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ■ | ○ | ○ | 1 |
2 | Turrula [30] | Finland | English | Cup and Stem | Case series | ○ | ○ | ○ | ○ | ■ | ○ | ○ | ■ | ○ | ○ | 2 |
3 | Cracchiolo [58] | USA | English | Cup and stem | Case series | ○ | ○ | ○ | ○ | ○ | ○ | ■ | ■ | ○ | ○ | 2 |
4 | Kirk et al. [28] | Canada | English | Cup and stem | Comparative | ■ | ○ | ○ | ■ | ○ | ○ | ○ | ○ | ○ | ○ | 2 |
5 | Lachiewicz [59] | USA | English | Cup and stem | Case series | ○ | ■ | ■ | ○ | ■ | ■ | ■ | ■ | ■ | ○ | 7 |
6 | Learmonth [60] | UK | English | Cup | Case series | ○ | ■ | ■ | ■ | ■ | ○ | ■ | ■ | ○ | ○ | 6 |
7 | Walker [41] | USA | English | Stem | Case series | ○ | ■ | ○ | ○ | ○ | ■ | ■ | ■ | ■ | ○ | 5 |
8 | Araujo [61] | Spain | English | Cup and stem | Case series, multicenter | ○ | ■ | ■ | ○ | ○ | ■ | ■ | ■ | ■ | ○ | 6 |
9 | Arnold [20] | Germany | German | Cup and stem | Comparative, multicenter | ■ | ■ | ○ | ■ | ○ | ■ | ■ | ○ | ■ | ○ | 6 |
10 | Dominkus [27] | Austria | English | Cup | Case series | ○ | ○ | ■ | ■ | ■ | ■ | ■ | ■ | ■ | ○ | 7 |
11 | Effenberqer [22] | Austria | German | Cup and stem | Case series | ○ | ○ | ○ | ■ | ○ | ■ | ■ | ■ | ■ | ○ | 5 |
12 | Lukoschek [40] | Germany | German | Cup and stem | Case series | ○ | ○ | ■ | ○ | ■ | ■ | ■ | ○ | ■ | ○ | 5 |
13 | Loehr [29] | Switzerland | English | Cup and stem | Case series | ○ | ○ | ○ | ■ | ○ | ■ | ○ | ■ | ■ | ○ | 4 |
14 | Jana [31] | USA | English | Cup and stem | Comparative cup, case series stem | ○ | ○ | ■ | ○ | ■ | ■ | ■ | ■ | ■ | ■ | 7 |
15 | Keisu [32] | USA | English | Cup and stem | Case series | ○ | ○ | ■ | ■ | ■ | ■ | ■ | ■ | ■ | ○ | 7 |
16 | Tanq [62] | China | English | Cup and stem | Comparative | ■ | ○ | ○ | ■ | ○ | ○ | ■ | ■ | ○ | ○ | 4 |
17 | Thomason [43] | USA | English | Cup and stem | Comparative stem, case series cup | ○ | ■ | ○ | ○ | ■ | ■ | ■ | ■ | ■ | ○ | 6 |
18 | Katsimihas [63] | UK | English | Cup | Case series | ○ | ■ | ■ | ■ | ■ | ■ | ■ | ■ | ■ | ○ | 8 |
19 | Smilowicz [24] | Poland | Polish | Cup and stem | Comparative | ■ | ○ | ○ | ○ | ○ | ■ | ■ | ○ | ○ | ○ | 3 |
20 | Eskelinen [36] | Finland | English | Cup and stem | Register | ■ | ○ | ○ | ■ | ○ | ■ | ■ | ■ | ■ | ■ | 7 |
21 | Gluscevic [35] | Yugoslavia | Serbian | Cup and stem | Comparative | ■ | ○ | ○ | ■ | ○ | ■ | ■ | ○ | ■ | ○ | 5 |
22 | Lyback [34] | Finland | English | Cup and stem | Case series | ○ | ○ | ■ | ○ | ○ | ■ | ■ | ■ | ■ | ○ | 5 |
23 | Hallan [44] | Norway | English | Stem | Register | ○ | ■ | ■ | ○ | ○ | ○ | ■ | ■ | ○ | ■ | 5 |
25 | Zwartele [25] | The Netherlands | English | Cup and stem | Case series | ○ | ○ | ■ | ■ | ■ | ■ | ■ | ■ | ■ | ○ | 7 |
24 | Zwartele [26] | The Netherlands | English | Cup and stem | Case series | ○ | ■ | ■ | ○ | ■ | ■ | ■ | ■ | ■ | ○ | 7 |
26 | Hailer [21] | Sweden | English | Cup and stem | Register | ○ | ○ | ○ | ○ | ○ | ■ | ■ | ■ | ■ | ■ | 5 |
27 | Rud-Sorensen [50] | Denmark | English | Cup and stem | Register | ○ | ○ | ○ | ■ | ○ | ■ | ■ | ■ | ○ | ■ | 5 |
28 | Makela [42] | Finland | English | Cup and stem | Register | ■ | ○ | ■ | ■ | ○ | ■ | ■ | ■ | ■ | ■ | 8 |
Acetabular component outcome
Acetabular component | Femoral component | ||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Number of cups | Mean follow-up in years | Acetabular fractures | Migration | Early loosening | Failures due to aseptic loosening | Failure rate | Number of stems | Mean follow-up in years | Femoral fractures | Fracture type | Fracture treatment | Subsidence | Early loosening | Failures due to aseptic loosening | Failure rate | ||
1 | Hoikka [42] | 36 | 1.1 | 0 | 0 | 0 | 0 | 0 | 36 | 1.1 | 2 | 2 type A | cons. | 0 | 1 | 1 | 2.5 |
2 | Turrula [30] | 62 | 1 | 0 | 0 | 1 | 0 | 0 | 62 | 1 | 21 | nr | 3 fixation | 3 | 0 | 0 | 0 |
3 | Cracchiolo [58] | 40 | 3.7 | 0 | 1 | 0 | 0 | 0 | 40 | 3.7 | 3 | 3 type A | 2 fixation | 2 | 0 | 0 | 0 |
4 | Kirk [28] | 25 | 3 | nr | 3 | 0 | 0 | 0 | 25 | 3 | nr | 3 | 0 | 0 | 0 | ||
5 | Lachiewicz [59] | 35 | 4.5 | 0 | 0 | 0 | 0 | 0 | 35 | 4.5 | 0 | 3 | 0 | 0 | 0 | ||
6 | Learmonth [60] | 78 | 3.8 | 0 | 0 | 0 | 0 | 0 | a | a | a | a | a | a | a | ||
7 | Walker [41] | a | a | a | a | a | a | a | 34 | 5.5 | nr | 4 | 0 | 1 | 0.5 | ||
8 | Araujo [61] | 33 | 5 | 0 | 0 | 0 | 0 | 0 | 33 | 5 | 3 | 3 type A | cons. | 2 | 0 | 0 | 0 |
9 | Arnold [20] | 386 | 6.9 | 2.0% | nr | nr | 31 | 1.2 | 198 | 6.9 | 5.5% | nr | nr | nr | 0 | 5 | 0.4 |
10 | Dominkus [27] | 82 | 7.3 | 0 | 8 | 3 | 3 | 0.5 | a | a | a | a | a | a | a | ||
11 | Effenberger [22] | 89 | 4.5 | 0 | 2 | 0 | 8 | 2 | 87 | 4.5 | 0 | 0 | 0 | 4 | 1 | ||
12 | Lukoschek [40] | 26 | 4.8 | 0 | 0 | 0 | 4 | 3.2 | 26 | 4.8 | 0 | 0 | 0 | 0 | 0 | ||
13 | Loehr [29] | 21 | 3.3 | 0 | 5 | 0 | 0 | 0 | 21 | 3.3 | 1 | 1 type A | 1 fixation | 3 | 0 | 0 | 0 |
14 | Jana [31] | 59 | 11 | nr | nr | 1 | 10 | 1.5 | 71 | 11 | nr | nr | 0 | 5 | 0.6 | ||
15 | Keisu [32] | 50 | 8 | 0 | 0 | 0 | 7 | 1.8 | 50 | 8 | 0 | 0 | 0 | 0 | 0 | ||
16 | Tang [62] | 17 | 8.4 | nr | nr | nr | 0 | 0 | 17 | 8.4 | nr | 2 | 0 | 0 | 0 | ||
17 | Thomason [43] | 98 | 7.4 | 0 | 0 | 0 | 2 | 0.3 | 51 | 7.4 | 1 | 1 type A | 1 fixation | 4 | 0 | 6 | 1.6 |
18 | Katsimihas [63] | 82 | 9.1 | 0 | 0 | 0 | 0 | 0 | a | a | a | a | a | a | a | ||
19 | Smilowicz [24] | 122 | 14 | 3 | 2 | nr | 7 | 0.4 | 122 | 14 | nr | 56 | nr | 5 | 0.3 | ||
20 | Gluscevic [35] | 85 | 6.8 | 0 | nr | nr | 3 | 0.5 | 85 | 6.8 | 1 | 1 type A | nr | nr | nr | 0 | 0 |
21 | Lyback [34] | 60 | 13.8 | nr | nr | 0 | 22 | 2.7 | 60 | 13.8 | nr | nr | 0 | 5 | 0.6 | ||
23 | Zwartele II [25] | 77 | 12.5 | 4 | 0 | 2 | 4 | 0.4 | 77 | 12.5 | 11 | 11 type A | 1 fixation | 0 | 0 | 1 | 0.1 |
22 | Zwartele I [26] | 76 | 5.8 | 3 | 0 | 1 | 4 | 0.9 | 76 | 5.8 | nr | nr | 0 | 1 | 0.2 |
Source | Study design | Mean FU in years | Diagnosis and design | Number of implants | Results | |
---|---|---|---|---|---|---|
Eskelinen [36] Finland | Comparison between uncemented and cemented cups in RA patients younger than 55 years | 2,557 | Survival at 10 years with aseptic loosening as end point | Risk ratio for revision for aseptic loosening | ||
8.5 | RA: UC (PPU) | 770 | 92% (95% CI:89–94) | 1.0 (95% CI: 0.8–1.4) | ||
10.9 | RA: UC (SU) | 317 | 74% (95% CI:68–79) | 2.7 (95% CI: 2.1–3.5) | ||
12.3 | RA: CE | 885 | 91% (95% CI:89–94) | 1.0 | ||
Hailer [38] Sweden | Comparison between uncemented and cemented cups in the general population. No differentiation for fixation method within the 5397 RA patients. | 170,413 | Risk ratio for revision for aseptic loosening of five most common uncemented and cemented cups | |||
3.2 | OA + RA: UC | nr | nr | 0.5 (95% CI: 0.3–0.8) | ||
5.8 | OA + RA: CE | nr | nr | 1.0 | ||
Rud-Sorensen [39] Denmark | Comparison between RA and OA patients. No differentiation for uncemented or cemented cups | 5.9 | Cumulative risk on revision for aseptic loosening at 14 years | |||
OA: UC + CE | 64,858 | 4.6% (95% CI: 4.0–5.1 | ||||
RA: UC + CE | 1,661 | 5.7% (95% CI: 3.7–8.8) | ||||
RA: UC | 878 | nr | ||||
RA: CE | 783 | nr | ||||
Makela [37] Finland | Comparison between uncemented and cemented cups in RA patients 55 years and older. Exclusion of implants with well-documented poor results | Survival at 10 years with aseptic loosening as end point | Risk ratio for revision for aseptic loosening | |||
8.2 | RA: UC | 579 | 97% (95% CI: 95–99) | 0.57 (95% CI: 0.36–0.92) | ||
7.7 | RA: CE | 3,440 | 94% (95% CI: 93–95) | 1.0 |
Femoral component outcome
Source | Study design | Mean FU in years | Diagnosis and design | Number of implants | Results | |
---|---|---|---|---|---|---|
Eskelinen [36] Finland | Comparison between uncemented and cemented stems in RA patients younger than 55 years | 2,557 | Survival at 10 years with aseptic loosening as end point | Risk ratio for revision for aseptic loosening | ||
8 | RA: UC (PPU) | 913 | 97% (95% CI:96–99) | 0.4 (95% CI:0.3–0.6) | ||
8.5 | RA: UC (UU) | 230 | 86% (95% CI:80–91) | 1.7 (95% CI:1.2–2.5) | ||
8.5 | RA: CE | 878 | 90% (95% CI:88–92) | 1.0 | ||
Hallan [44] Norway | Uncemented stems in the general population. No differentiation between population and the 5.5% RA patients | Survival at 10 years with aseptic loosening as end point (the 8 most used stems) | Risk ratio for revision for aseptic loosening | |||
OA + RA:UC | 9,757 | 96 to 100% | Diagnosis did not influence the results | |||
Hailer [38] Sweden | Comparison between uncemented and cemented stems in the general population. No differentiation for fixation method within the 5397 RA patients | 170,413 | Risk ratio for revision for aseptic loosening of the five most common uncemented and cemented stems | |||
5.1 | OA + RA: UC | nr | nr | 0.3 (95% CI:0.2–0.4) | ||
5.8 | OA + RA: CE | nr | nr | 1.0 | ||
Rud-Sorensen [39] Denmark | Comparison between RA and OA patients. No differentiation for uncemented or cemented stems | 5.9 | Cumulative risk on revision for aseptic loosening at 14 years | |||
OA: UC + CE | 64,858 | 4.3% (95% CI:3.8–4.8) | ||||
RA: UC + CE | 1,661 | 3.2% (95% CI:1.8–5.9) | ||||
RA: UC | 446 | nr | ||||
RA: CE | 1,215 | nr | ||||
Makela [37] Finland | Comparison between uncemented and cemented THA in RA patients 55 years and older. Exclusion of implants with well-documented poor results | Survival at 10 years with aseptic loosening as end point | Risk ratio for revision for aseptic loosening | |||
8.2 | RA: UC | 579 | 98% (95% CI:97–100) | 0.39 (95% CI:0.20–0.76) | ||
7.7 | RA: CE (LT) | 1,535 | 96% (95% CI:94–97) | 1.0 | ||
RA: CE (CB) | 1,905 | 92% (95% CI:90–94) | 1.85 (95% CI:1.34–2.55) |