Introduction
Methods
Results
Study
|
Study design
|
Sample size (HA/control)
|
Mean ages of patients (years)
|
Sex distribution (female/male)
|
Inclusion criteria
|
---|---|---|---|---|---|
Camazzola et al. [28] | RCT | 61 (34/27) | 48.2 ± 9.0/50.4 ± 8.7 | 22/39 | Men younger than 60 years and women younger than 65 years having elective primary THA |
Dorr et al. [16] | Retrospective, matched pair | 30 (15/15) | 55 (38–71) | 10/5 | Patients who underwent bilateral primary THA |
Hamadouche et al. [34] | RCT | 45 (22/23) | 65/64 | 41/39 | Patients with osteoarthritis of the hip requiring THA |
Incavo et al. [32] | RCT | 50 (24/26) | 55 | NR | Patients who underwent THA |
Kim et al. [23] | RCT | 100 (50/50) | 45.3 (27–61) | 14/36 | Patients who underwent sequential bilateral primary THA |
Kim et al. [24] | RCT | 110 (55/55) | 46.3 (27–63) | 39/16 | Patients who underwent bilateral primary THA |
Lee and Lee 2007 [33] | RCT | 40 (20/20) | 44 (25–72) | 2/18 | Patients who had late-stage bilateral osteonecrosis were randomly treated with bilateral THA |
Lombardi Jr. et al. [12] | Retrospective, observational study | 131 (46/85) | 52 (29–72)/51 (22–78) | 67/97 | Patients who underwent THA using a MHP |
Mcpherson et al. [36] | Retrospective, matched pair | 84 (42/42) | 55 ± 11.4/56.5 ± 11.7 | 36/48 | Patients of the same gender, bone type, activity level, and diagnosis, ages within 5 years, weight within 25 pounds, Charnley activity class |
Parvizi et al. [9] | Prospective, matched-pair | 86 (43/43) | 66.8 ± 6.2/65.7 ± 5.9 | NR | The patients matched for age, sex, weight, diagnosis, Charnley class, operative approach, bone quality, femoral head size, type of acetabular component, and duration of follow-up |
Paulsen et al. [38] | Retrospective comparison | 3,158/4,749 | NR | 3,834/4,073 | Patients underwent primary uncemented THA, who were younger than 70 years of age at surgery |
Ranawat et al. [35] | RCT | 174 (92/82) | 54.9 (29.4–67.5)/55.5 (28.6–71.8) | 38/114 | Patients received cementless THA with the Ranawat-Burstein metaphyseal-diaphyseal fit hip system |
Rothman et al. [10] | Retrospective, matched pair | 104 (52/52) | 64 (31.2–86.1) | 49/49 | Consecutive THA with use of Taperloc stem, matched for age, sex, weight, diagnosis, Charnley class, operative approach, and duration of follow-up |
Sanchez-Sotelo et al. [37] | Retrospective, matched-pair | 136 (68/68) | 54 (23–66)/56 (22–67) | 56/80 | Patients who had a primary hip replacement with insertion of either a porous-coated or HA-coated Omniflex femoral componene |
Sano et al. [39] | Retrospective, observational study | 55 (24/31) | 64.0 (51–83)/62.7 (41–80) | 49/3 | Patients in whom surgery was performed at least 2 years before the present study |
Santori et al. [14] | Retrospective, observational study | 227 (158/69) | NR | NR | Patients underwent THA with the anatomic prosthesis |
Søballe et al. [4] | RCT | 26 (14/12) | 56.8 (48–63)/58.6 (50–68) | NR | Patients who underwent THR to receive prosthetic with either Ti-alloy coating or HA coating |
Tanzer et al. [22] | RCT | 39 (17/22) | 66 (54–80)/64 (43–78) | 13/26 | Patients undergoing a cementless THA |
Tanzer et al. [31] | RCT | 318 (164/154) | 64.5 ± 9.9/63.1 ± 10.5 | 153/165 | All patients who underwent cementless THA |
Yee et al. [30] | RCT | 62 (35/27) | 48.2 ± 9.0/50.4 ± 8.7 | 11/22 | Men younger than 60 years of age and women younger than 65 years of age undergoing primary THA |
Yoon et al. [29] | RCT | 75 (37/38) | 45.3 (20–69)/46.0 (23–71) | 14/49 | Patients who underwent THA use a multilock femoral stem with or without HA/TCP coating |
Study
|
Purity and thickness of HA
|
Surgery approach
|
Co-factors
|
Follow-up (years)
|
Missing information
|
Hip implant
|
Outcome measurement
|
---|---|---|---|---|---|---|---|
Camazzola et al. [28] | NR | Hardinge approach | Routine antibiotic prophylaxis; anticoagulation with dicumarin was used preoperatively and for a total of 3 months postoperatively, full weight-bearing for 6 weeks | 13 years and 5 months (12–15 years and 3 months) | 4 patients were lost to follow-up, 8 died. 1 refuced to participate in the questionnaire or clinical follow-up | Mallory-Head porous stem (Biomet) | HHS, radiographic outcome, thigh pain, survival |
Dorr et al. [16] | 94% purity, 50–60 μm | NR | NR | 6.5 (5–7.9) | No | Anatomic porous replacement—I hip stem (Intermedics Ortho) | HHS, radiographic outcome |
Hamadouche et al. [34] | 100 ± 30 μm | Posterolateral approach and a Hardinge lateral approach | Postoperative management include administration of systemic antibiotics for 48 h, preventative anticoagulation therapy until full weight-bearing, and NSAID for 5 days to prevent heterotopic ossification, partial weight-bearing was allowed for 6 weeks followed by full weight-bearing | 9.18 (3.93–10.28) | One patient from each group died from an unrelated cause at three months and at 27 months after surgery, three patients were lost to follow-up at a mean of three years, of these, one belonged to the HA and two to the GB group | Profile (DePuy) | HHS, radiographic outcome |
Incavo et al. [32] | NR | NR | NR | 4 | no | ProWle (DePuy) | HHS, radiographic outcome |
Kim et al. [23] | 30 μm | Posterolateral approach | Stand on the second postoperative day. Partial weight-bearing with crutches as tolerated, full weight-bearing was allowed at 6 weeks after surgery | 6.6 (5–7) | No | Cementless IPS femoral component (DePuy) | HHS, functional outcome, thigh pain, radiographic outcome, survivorship, complications |
Kim et al. [24] | 30 μm | Posterolateral approach | NR | 15.6 (15–16) | 3 were lost to follow-up, 2 died | IPS femoral stem (DePuy) | HHS, WOMAC, thigh pain, Los Angeles activity score, survivorship |
Lee and Lee 2007 [33] | 98% purity, 150–250 μm | Direct lateral approach (transgluteal approach) | Hip joint motion and ambulation using a wheelchair were allowed from the first postoperative week, crutch walking with partial weight-bearing began 3 to 4 weeks after the second operation. In addition, the patients used a cane for additional 2 to 4 months until they could walk well without any support | 143 (123–168) | 4 patients died, 5 patients were lost | Spotorno (Zimmer) | Merle d’Aubigne and Postel score, radiographic outcome |
Lombardi, Jr. et al. [12] | 95% purity, 50–75 μm | NR | Routine clinical evaluation was performed under the supervision of the operative surgeons | 14.5 (10.2–16.6)/16.9 (11.4–18.5) | 27 patients in the MHP group and 5 patients in the MHP HA group were decreased from causes unrelated to the index surgery. In addition, 14 patients (14 hips, 10.8%) in the MHP group and nine patients (10 hips, 16.4%) in the MHP HA group had not returned for minimum 10-year follow-up and were lost to contact | Mallory-Head porous stem (Biomet) | HHS, radiographic findings, survival |
Mcpherson et al. [36] | 94% purity, 50–60 μm | NR | NR | 3 | No | Anatomic porous replacement—I hip stem (intermedics orthopedics) | HHS, radiographic fixation scores |
Parvizi et al. [9] | NR | NR | NR | 9.2 ± 4.8/10.1 ± 4.6 | Each one of the members of nine pairs of patients is dead | Taperloc, Biomet, Warsaw, Indiana | HHS, radiographic findings |
Paulsen et al. [38] | 95–97% purity, 50–75 μm | NR | NR | 3.2 | No | Biometric (Biomet) | Time to implant failure |
Ranawat et al. [35] | 95% purity, 50–75 μm | Posterolateral approach | Standard postoperative rehabilitation protocol | 5 (3–8) for thigh pain, 17.7 + −0.8 (16.3–20) | 53 patients were deceased, 28 patients were lost to follow-up | Ranawat-Burstein metaphyseal-diaphyseal fit femoral stem (Biomet) | HSS, functional outcome(patient assessment questionnaire), incidence of pain, radiographic outcome, stem subsidence Kaplan-Meier survivorship |
Rothman et al. [10] | 95% purity, 50–75 μm | NR | Prophylactic antibiotics were given intravenously at the time of the operation and were continued for 48 h. Ten milligrams of low-dose warfarin was given on the night of the operation, instructed to bear only 10% of the body weight on the affected limb for 6 weeks, at which time, they progressed to use of a cane | 2.2 (2–3.4) | No | Taperloc stem (Biomet) | Charnley scores, radiographic outcome |
Sanchez-Sotelo et al. [37] | NR | NR | NR | 6.7 (2.4–9.1)/9.3 (2.2–11.4) | No | Omniflex stem (Osteonics Corporation) | HHS, radiographs, survival |
Sano et al. [39] | NR | Posterior approach | Partial weight-bearing was allowed 1 week after the operation, with full weight-bearing after 3 weeks | 34/52 m | No | Biomet (Warsaw); Stryker(Fairfield Rd) | HHS, BMD, radiographic outcome |
Santori et al. [14] | 70% purity, 80–130 μm | NR | Partial weight bearing with two canes was allowed on the fifth postoperative day and progressed to one cane on day 30 | 70 m (60–84) | No | Anatomic prosthesis (Zimmer) | HHS, thigh pain, radiographic evaluation |
Søballe et al. [4] | 50–75 μm | Posterolateral approach | Prophylactic antibiotics and anti-thromboembolic drugs, mobilized on the third postoperative day and instructed to walk with protected weight-bearing for the first six postoperative weeks | 1 | 11 patients were excluded from RSA because of technical errors, 1 patient with bilateral THR died from unrelated disease | Biometric (Biomet) | HHS, the visual analog scale score, radiographs data, RSA |
Tanzer et al. [22] | 80% HA, 20% TCP, 80 μm | Posterolateral approach | All patients remained non-weight-bearing for 6 weeks, followed by progressive weight-bearing as tolerated | 2 | No | Cementless multilock stem (Zimmer) | HHS, periprosthetic BMD measurement |
Tanzer et al. [31] | 80% HA, 20% TCP, 80 μm | Posterolateral approach for 64% and 69% in groups uncoated and coated, lateral approach was used in the remainder | All patients were non-weight-bearing for 6 weeks postoperatively, followed by progressive weight-bearing as tolerated | 37 m (2–5 years) | 16 patients in the group with uncoated and 11 patients in the group with coated components withdraw or were lost to follow-up; 4 in uncoated and 3 in coated died | Cementless multilock stem (Zimmer) | HHS, WOMAC, radiographic data |
Yee et al. [30] | 95% purity, 50–70 μm | A modified lateral Hardinge approach | Routine prophylactic antibiotic(cefazolin sodium) was administered before surgery and 48 h after surgery; anticoagulation with dicumarin was given: 5 mg orally the night before surgery and daily for a duration of 3 months after surgery. Physical therapy was commenced on the first or second day after surgery. Tough weight-bearing with crutches for 6 weeks was allowed for uncomplicated cases. Progression to full weight-bearing as tolerated was allowed after 6 weeks | 4.6 (3–7) | 6 patients were lost to follow-up, 1 died of cardiac causes.1 patient declined additional participation in the study after surgery, 1 with bilateral THA was involved in a motor vehicle accident that resulted in a periprosthetic fracture of one hip | Mallory-Head porous femoral stem (Biomet) | HHS, routine radiographs, survivorship |
Yoon et al. [29] | 70% HA, 30% TCP, 70 μm | Hardinge’s lateral approach | Instruted to walk with partial weight-bearing with the aid of 2 crutches for 4 weeks after surgery | 127.4 m (96–144)/127 (108–144) | 2 patients in the coated group died of myocardial infarction and cerebral infarction, 2 patients in coated and 2 in uncoated were lost to follow-up | Multilock femoral stem (Zimmer) | HHS, radiographic evaluation, thigh pain |
Study
|
Randomized adequately
a
|
Allocation concealed
|
Similar baseline
|
Patient blinded
|
Care provider blinded
|
Outcome assessor blinded
|
Avoid selective reporting
|
Similar or avoided cofactors
|
Patients’ compliance
b
|
Acceptable drop-out rate
c
|
Similar timing
|
ITT analysis
d
|
Quality
e
|
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Hamadouche et al. [34] | Yes | Unclear | Yes | Unclear | Unclear | Yes | Yes | Yes | Yes | Yes | Yes | No | High |
Incavo et al. [32] | Yes | Unclear | Yes | Unclear | Unclear | Unclear | Yes | Yes | Yes | Yes | Yes | No | High |
Kim et al. [23] | Yes | Yes | Yes | Unclear | Unclear | Unclear | Yes | Yes | Yes | Yes | Yes | No | High |
Kim et al. [24] | Yes | Unclear | Yes | Yes | Unclear | Yes | Yes | Yes | Yes | Yes | Yes | No | High |
Lee and Lee [33] | Yes | Unclear | Yes | Unclear | Unclear | Unclear | Yes | Yes | Yes | Yes | Yes | No | High |
Søballe et al. [4] | Yes | Yes | Yes | Unclear | Unclear | Yes | Yes | Yes | Yes | Yes | Yes | No | High |
Tanzer et al. [22] | Yes | Yes | Yes | Unclear | Unclear | Unclear | Yes | Yes | Yes | Yes | Yes | No | High |
Tanzer et al. [31] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No | High |
Yee et al. [30] | Yes | Unclear | Yes | Unclear | Unclear | Yes | Yes | Yes | Yes | Yes | Yes | No | High |
Yoon et al. [29] | Yes | Yes | Yes | Unclear | Unclear | Unclear | Yes | Yes | Yes | Yes | Yes | No | High |
Camazzola et al. [28] | Yes | Unclear | Yes | Unclear | Unclear | Yes | Yes | Yes | Yes | No | Yes | No | Moderate |
Dorr et al. [16] | Unclear | Unclear | Yes | Unclear | Unclear | Unclear | Yes | Yes | Yes | Unclear | Yes | Unclear | Moderate |
Lombardi, Jr. et al. [12] | Unclear | Unclear | Yes | Unclear | Unclear | Unclear | Yes | Yes | Yes | No | Yes | No | Moderate |
Mcpherson et al. [36] | Unclear | Unclear | Yes | Yes | Unclear | Unclear | Yes | Yes | Yes | Yes | Yes | No | Moderate |
Parvizi et al. [9] | Unclear | Unclear | Yes | Unclear | Unclear | Unclear | Yes | Yes | Yes | Yes | Yes | No | Moderate |
Paulsen et al. [38] | Unclear | Unclear | Yes | Unclear | Unclear | Unclear | Yes | Yes | Yes | Yes | Yes | No | Moderate |
Ranawat et al. [35] | Yes | Unclear | Yes | Unclear | Unclear | Unclear | Yes | Yes | Yes | No | Yes | No | Moderate |
Rothman et al. [10] | No | Unclear | Yes | No | No | Yes | Yes | Yes | Yes | Yes | Yes | No | Moderate |
Sanchez-Sotelo et al. [37] | Unclear | Unclear | Yes | Unclear | Unclear | Unclear | Yes | Yesc | Yes | Yes | Yes | No | Moderate |
Sano et al. [39] | Unclear | Unclear | Yes | Unclear | Unclear | Unclear | Yes | Yes | Yes | Yes | Yes | No | Moderate |
Santori et al. [14] | Unclear | Unclear | Yes | Unclear | Unclear | Unclear | Yes | Yes | Yes | Yes | Yes | No | Moderate |
Factors
|
Harris hip score
|
Survival
|
Incidence of thigh pain
|
Radiolucent lines
|
Femoral osteolysis
|
Polyethylene wear
| ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Subgroups (numbers)
|
WMD (95% CI)
|
Subgroups (numbers)
|
RR (95% CI)
|
Subgroups (numbers)
|
OR (95% CI)
|
Subgroups (numbers)
|
OR (95% CI)
|
Subgroups (numbers)
|
OR (95% CI)
|
Subgroups (numbers)
|
WMD (95% CI)
| |
Study design | RCT (10) | 1.41 (0.30, 2.52) | RCT (10) | 1.01 (0.99, 1.02) | RCT (4) | 0.73 (0.42, 1.28) | RCT (4) | 0.95 (0.65, 1.39) | RCT (2) | 1.37 (0.45, 4.17) | RCT (4) | N.A. |
Non-RCT (5) | 2.29 (0.50, 4.07) | Non-RCT (6) | 1.00 (0.99, 1.00) | Non-RCT (2) | 0.14 (0.04, 0.49) | Non-RCT (2) | 0.96 (0.41, 2.24) | Non-RCT (3) | 0.39 (0.22, 0.70) | Non-RCT (0) | ||
p = 0.42 |
p = 0.27 |
p = 0.02
|
p = 0.98 |
p = 0.05
| ||||||||
Study quality | High (9) | 1.41 (0.30, 2.52) | High (8) | 1.01 (0.99, 1.02) | High (3) | 1.29 (0.57, 2.88) | High (4) | 0.95 (0.65, 1.39) | High (2) | 1.24 (0.38, 4.13) | High (4) | N.A. |
Moderate (6) | 2.28 (0.50, 4.07) | Moderate (8) | 1.00 (0.99, 1.00) | Moderate (3) | 0.30 (0.15, 0.57) | Moderate (2) | 0.96 (0.41, 2.24) | Moderate (2) | 0.42 (0.24, 0.74) | Moderate (0) | ||
p = 0.42 |
p = 0.27 |
p = 0.006
|
p = 0.98 |
p = 0.11 | ||||||||
Thickness of HA | 50–80 μm (8) | 0.76 (−0.63, 2.15) | 50–80 μm (10) | 1.00 (0.99, 1.00) | 50–80 μm (3) | 0.71 (0.40, 1.27) | 50–80 μm (5) | N.A. | 50–80 μm (3) | N.A. | 50–80 μm (2) | 0.00 (−0.01, 0.01) |
<50 μm or >80 μm (3) | 2.03 (0.41, 3.64) | <50 μm or >80 μm (4) | 1.02 (0.98, 1.06) | <50 μm or >80 μm (2) | 0.19 (0.06, 0.58) | <50 μm or >80 μm (0) | <50 μm or >80 μm (0) | <50 μm or >80 μm (2) | −0.03 (−0.03, −0.03) | |||
p = 0.24 |
p = 0.23 |
p = 0.04
|
p < 0.00001
| |||||||||
Purity of HA | >90% (4) | −0.09 (−3.04, 2.86) | >90% (7) | 1.00 (0.99, 1.00) | >90% (2) | 0.68 (0.36, 1.26) | >90% (3) | 0.73 (0.31, 1.71) | >90% (2) | 0.66 (0.27, 1.62) | >90% (1) | 0.01 (−0.06, 0.08) |
<90% (3) | 0.82 (−0.77, 2.42) | <90% (3) | 1.00 (0.98, 1.02) | <90% (3) | 0.23 (0.08, 0.65) | <90% (2) | 0.93 (0.61, 1.40) | <90% (1) | 1.24 (0.38, 4.13) | <90% (1) | 0.00 (−0.01, 0.01) | |
p = 0.59 |
p = 0.72 |
p = 0.08 |
p = 0.63 |
p = 0.4 |
p = 0.79 | |||||||
Implant design | Anatomic (5) | 1.65 (0.15, 3.16) | Anatomic (4) | 1.02 (0.99, 1.05) | Anatomic (2) | 0.19 (0.06, 0.58) | Anatomic (1) | 0.32 (0.07, 1.47 | Anatomic (2) | 0.66 (0.27, 1.62) | Anatomic (2) | −0.03 (−0.03, −0.03) |
Non-anatomic (10) | 1.66 (0.44, 2.87) | Non-anatomic (12) | 1.00 (1.00, 1.00) | Non-anatomic (4) | 0.72 (0.41, 1.28) | Non-anatomic (5) | 1.01 (0.71, 1.45) | Non-anatomic (3) | 0.46 (0.25, 0.85 | Non-anatomic (2) | 0.00 (−0.01, 0.01) | |
p = 1.00 |
p = 0.24 |
p = 0.04
|
p = 0.15 |
p = 0.52 |
p < 0.00001
| |||||||
Follow-up duration | >6 years (9) | 2.21 (1.05, 3.37) | >6 years (10) | 1.01 (0.99, 1.03) | >6 years (4) | 0.56 (0.29, 1.08) | >6 years (2) | 0.58 (0.24, 1.43) | >6 years (4) | 0.44 (0.24, 0.77) | >6 years (3) | −0.02 (−0.02, −0.01) |
<6 years (6) | 0.58 (−1.04, 2.20) | <6 years (6) | 1.00 (0.99, 1.00) | <6 years (2) | 0.50 (0.24, 1.05) | <6 years (4) | 1.04 (0.71, 1.52) | <6 years (1) | 1.00 (0.32, 3.15) | <6 years (1) | 0.01 (−0.06, 0.08) | |
p = 0.11 |
p = 0.11 |
p = 0.82 |
p = 0.25 |
p = 0.2 |
p = 0.46 |