Department of Orthopedic Surgery, Children's Hospital Boston, 300 Longwood Avenue, Enders 260, Boston, MA 02115, USA.
J Bone Joint Surg Am. 2013 Feb 6;95(3):215-21. doi: 10.2106/JBJS.L.00286.
The objective of this study was to conduct a meta-analysis and cost-effectiveness analysis of the effect of glenoid design on radiolucency, loosening, and revision after total shoulder arthroplasty.
We conducted a systematic review of PubMed, MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and CINAHL with use of a search for the terms arthroplasty AND shoulder AND (peg OR keel). Data on study design and on the end points of radiolucency, loosening, and revision were extracted independently and in duplicate. Random-effect models were used to calculate the pooled risk ratio and risk difference. The risk difference was used to estimate the number needed to treat (the number of individuals who would have to receive a pegged component to avoid one loosening or revision).
Eight studies with a total of 1460 patients (mean age, sixty-seven years) were included. The mean study quality was 1.75 points (95% confidence interval [CI], 1.26 to 2.24) on the 3-point modified Jadad scale. There was no significant difference in the risk of any radiolucency (risk ratio, 0.42; 95% CI, 0.12 to 1.42) or in the risk of severe radiolucency (risk ratio, 0.65; 95% CI, 0.23 to 1.82) between pegged and keeled components. The pooled risk ratio for revision was 0.27 (95% CI, 0.08 to 0.88) in favor of pegged components (p = 0.028). At a cost-effectiveness threshold of $50,000 per quality-adjusted life year, pegged components can be between $2325 and $40,920 more expensive than keeled components and still be cost-effective.
Our study produced evidence that pegged glenoid components were associated with a lower revision risk compared with keeled components. However, the difference was rather small and will therefore be most meaningful to high-volume shoulder arthroplasty centers. Because of the similarity between primary and secondary costs, pegged glenoid designs were more cost-effective than keeled glenoid designs.
本研究旨在进行荟萃分析和成本效益分析，以评估肩胛盂设计对全肩关节置换术后透亮线、松动和翻修的影响。
我们对 PubMed、MEDLINE、Embase、Cochrane 对照试验中心注册库和 CINAHL 进行了系统评价，使用的检索词为“关节成形术”和“肩”以及（钉或龙骨）。独立并重复提取研究设计和透亮线、松动和翻修终点的数据。使用随机效应模型计算汇总风险比和风险差异。风险差异用于估计需要治疗的人数（即需要接受钉状组件治疗以避免一次松动或翻修的人数）。
纳入了 8 项共 1460 例患者（平均年龄 67 岁）的研究。基于 3 分改良 Jadad 量表，平均研究质量评分为 1.75 分（95%置信区间[CI]，1.26 至 2.24）。钉状和龙骨状组件在任何透亮线（风险比，0.42；95%CI，0.12 至 1.42）或严重透亮线（风险比，0.65；95%CI，0.23 至 1.82）的风险方面无显著差异。翻修的汇总风险比有利于钉状组件，为 0.27（95%CI，0.08 至 0.88）（p = 0.028）。在每质量调整生命年 50000 美元的成本效益阈值下，钉状组件比龙骨状组件贵 2325 至 40920 美元仍具有成本效益。
我们的研究结果表明，与龙骨状组件相比，钉状肩胛盂组件与较低的翻修风险相关。然而，差异相当小，因此对高容量肩关节置换中心最有意义。由于主要和次要成本之间的相似性，钉状肩胛盂设计比龙骨状肩胛盂设计更具成本效益。
