Rothman Institute of Orthopedics, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA.
J Bone Joint Surg Am. 2013 Jan 16;95(2):168-74. doi: 10.2106/JBJS.K.01652.
The use of cementless acetabular components in total hip arthroplasty has gained popularity over the past decade. Most total hip arthroplasties being performed in North America currently use cementless acetabular components. The objective of this systematic review and meta-analysis was to compare the survivorship and revision rate of cemented and cementless acetabular components utilized in total hip arthroplasty.
A primary literature search in PubMed identified 3488 articles, of which 3407 did not meet the inclusion criteria and were excluded. Only English-language articles on either the survivorship or revision rate of primary total hip arthroplasty at a minimum of ten years of follow-up were included. The present study analyzed forty-five articles reporting the long-term outcome of cementless acetabular components, twenty-nine reporting the outcome of cemented acetabular components, and seven comparing cemented and cementless acetabular components. Meta-analysis (with a random-effects model) was performed on the data from the seven comparative studies, and study-level logistic regression analysis (with a quasibinomial model) was performed on the pooled data on the eighty-one included articles to determine a consensus. The studies were weighted according to the number of total hip arthroplasties performed.
The meta-analysis did not reveal any effect of the type of acetabular component fixation on either survivorship or revision rate. The regression analysis revealed the estimated odds ratio for survivorship of a cemented acetabular component to be 1.60 (95% confidence interval, 1.32 to 2.40; p = 0.002) when adjustments for factors including age, sex, and mean duration of follow-up were made.
The preference for cementless acetabular components on the basis of improved survivorship is not supported by the published evidence. Although concerns regarding aseptic loosening of cemented acetabular components may have led North American surgeons toward the nearly exclusive use of cementless acetabular components, the available literature suggests that the fixation of cemented acetabular components is more reliable than that of cementless components beyond the first postoperative decade.
在过去的十年中，非骨水泥髋臼组件在全髋关节置换术中的应用越来越受欢迎。目前，北美的大多数全髋关节置换术都使用非骨水泥髋臼组件。本系统评价和荟萃分析的目的是比较全髋关节置换术中使用骨水泥髋臼组件和非骨水泥髋臼组件的生存率和翻修率。
在 PubMed 中进行初步文献检索，共检索到 3488 篇文章，其中 3407 篇不符合纳入标准而被排除。仅纳入至少随访 10 年的关于原发性全髋关节置换术后生存率或翻修率的英文文章。本研究分析了 45 篇报告非骨水泥髋臼组件长期结果的文章，29 篇报告骨水泥髋臼组件结果的文章，以及 7 篇比较骨水泥和非骨水泥髋臼组件的文章。对 7 项比较研究的数据进行荟萃分析（采用随机效应模型），对 81 篇纳入文章的汇总数据进行研究水平的逻辑回归分析（采用拟二项式模型），以确定共识。根据进行的全髋关节置换术数量对研究进行加权。
荟萃分析未显示髋臼组件固定类型对生存率或翻修率有任何影响。回归分析显示，在调整年龄、性别和平均随访时间等因素后，骨水泥髋臼组件生存率的估计优势比为 1.60（95%置信区间，1.32 至 2.40；p = 0.002）。
基于生存率提高的偏好，非骨水泥髋臼组件的使用并不能得到已发表证据的支持。尽管对骨水泥髋臼组件无菌松动的担忧可能导致北美外科医生几乎只使用非骨水泥髋臼组件，但现有文献表明，在术后的第一个十年之后，骨水泥髋臼组件的固定比非骨水泥组件更可靠。
