Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany.
Department of Cardiothoracic Surgery, RWTH Aachen University Clinic, Aachen, Germany.
Eur J Orthop Surg Traumatol. 2020 Apr;30(3):401-410. doi: 10.1007/s00590-019-02600-6. Epub 2019 Nov 26.
Hemiarthroplasty is commonly performed to treat femoral neck fractures. Still, there is a lack of consensus concerning the best component for hemiarthroplasty: unipolar and bipolar implants. Last meta-analysis on this topic is outdated, and an update of current evidences is required. The purpose of this study is to conduct a meta-analysis comparing the unipolar versus bipolar implants for hemiarthroplasty, focusing on the clinical scores, perioperative data, further complications and mortality rate.
In September 2019, the main databases were accessed: all the clinical trials comparing unipolar versus bipolar hemiarthroplasty for displaced femoral neck fractures were considered for inclusion. For the methodological quality assessment, we referred to the PEDro score. For the statistical analysis, we referred to the Review Manager 5.3 (The Nordic Cochrane Collaboration, Copenhagen). For implant survivorship, we referred to the STATA/MP software version 14.1 (StataCorp, College Station, Texas).
A total of 27 articles were considered for inclusion, consisting of 16 randomized and 11 non-randomized clinical trials. A total of 4511 patients were enrolled, undergoing a mean 21.26 months follow-up. A statistically significant reduction in the acetabular erosion was observed in the bipolar group (OR 3.16, P < 0.0001). Although statistically insignificant, the bipolar group reported a reduction in the mean Harris hip score, reduced surgical duration and hospitalization, reduced dislocation and revisions rate. Concerning the mortality, a reduction across all the follow-ups in favor of the bipolar group was detected, but without statistically significance.
This meta-analysis evidenced a reduction in the acetabular erosion after bipolar hemiarthroplasty compared to the unipolar implants. Any statistically significant difference concerning the other endpoints of interest was detected. Current evidence concerning this topic are controversial, and further randomized clinical trials are required.
半髋关节置换术常用于治疗股骨颈骨折。然而，对于半髋关节置换术的最佳假体，即单极和双极假体，仍缺乏共识。关于这个主题的最后一次荟萃分析已经过时，需要更新当前的证据。本研究的目的是进行一项荟萃分析，比较单极与双极假体在半髋关节置换术中的应用，重点关注临床评分、围手术期数据、进一步并发症和死亡率。
2019 年 9 月，我们检索了主要数据库：所有比较单极与双极半髋关节置换治疗移位股骨颈骨折的临床试验均被纳入研究。对于方法学质量评估，我们参考了 PEDro 评分。对于统计分析，我们参考了 Review Manager 5.3（北欧 Cochrane 协作组织，哥本哈根）。对于假体存活率，我们参考了 STATA/MP 软件版本 14.1（StataCorp，德克萨斯州 College Station）。
共纳入 27 篇文章，包括 16 篇随机对照试验和 11 篇非随机对照试验。共纳入 4511 例患者，平均随访 21.26 个月。双极组髋臼侧骨溶解的发生率显著降低（OR 3.16，P<0.0001）。虽然无统计学意义，但双极组的 Harris 髋关节评分平均值较低，手术时间和住院时间较短，脱位和翻修率较低。关于死亡率，在所有随访中，双极组的死亡率均有降低，但无统计学意义。
本荟萃分析表明，与单极假体相比，双极半髋关节置换术后髋臼侧骨溶解的发生率降低。在其他感兴趣的终点方面，未发现有统计学意义的差异。目前关于这一主题的证据存在争议，需要进一步的随机临床试验。
