Moskal Joseph T, Capps Susan G, Scanelli John A
Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Institute for Orthopaedics and Neurosciences at Carilion Clinic, Roanoke, VA, USA.
BENSOL, Warsaw, IN, USA.
Arthroplast Today. 2016 Sep 15;2(4):211-218. doi: 10.1016/j.artd.2016.02.001. eCollection 2016 Dec.
There is now a clear trend with increased usage of cementless femoral stems for all ages and most patients. As the number of total hip arthroplasties (THAs) performed annually continues to increase with expanding indications for THA and demands for improved quality of life, so will the prevalence of THA in the elderly and aging populations. This is worrisome as the risk of complications with cementless femoral stems increases in elderly patients and those with poor bone quality. The purpose of this study is to analyze the available data from comparative studies to determine whether cementless femoral stems are overused and whether cemented stems warrant increased consideration.
Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searches were performed to find original studies comparing cementless and cemented femoral stems; large population registry studies and reports were also included.
This systematic review documents that older patients with cementless fixation increase the risk of revision, there is no clear fixation advantage in midaged patients, and younger patients fare better with cementless fixation. Complications after THA create burdens on the health care system and on patients.
Using evidence-based data should be better guidance in selecting the most reliable implants for THA. Although cementless femoral fixation for THA has evolved to the "new standard," it has not been proven to be the "gold standard" for all patients.
目前，对于所有年龄段和大多数患者而言，非骨水泥型股骨柄的使用呈明显增加趋势。随着每年全髋关节置换术（THA）的数量随着THA适应证的扩大和对生活质量改善的需求而持续增加，THA在老年和老龄人群中的患病率也会上升。这令人担忧，因为老年患者和骨质量较差的患者使用非骨水泥型股骨柄时并发症风险会增加。本研究的目的是分析比较研究中的现有数据，以确定非骨水泥型股骨柄是否被过度使用，以及骨水泥型股骨柄是否值得更多考虑。
按照系统评价和Meta分析的首选报告项目指南进行检索，以查找比较非骨水泥型和骨水泥型股骨柄的原始研究；还纳入了大型人群登记研究和报告。
本系统评价表明，采用非骨水泥固定的老年患者翻修风险增加，中年患者没有明显的固定优势，而年轻患者采用非骨水泥固定效果更好。THA后的并发症给医疗保健系统和患者带来负担。
在为THA选择最可靠的植入物时，使用循证数据应能提供更好的指导。尽管THA的非骨水泥型股骨固定已发展成为“新标准”，但尚未被证明是所有患者的“金标准”。
