Zhang Zhen, Xing Qiqi, Li Jingyi, Jiang Zichao, Pan Yixiao, Hu Yihe, Wang Long
Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China.
Ann Transl Med. 2021 Feb;9(3):231. doi: 10.21037/atm-20-4043.
In total hip arthroplasty (THA), short-stem prostheses (SS) were designed to achieve better preservation of proximal femoral bone stock and stability than conventional stem prostheses (CS), however these effects are controversial. We aimed perform a systematic review and meta-analysis to evaluate the effectiveness of SS and CS in primary THA.
Relevant randomized controlled trials (RCTs) involving the comparison of SS and CS in primary THA were screened using the electronic databases PubMed, Embase and Web of Science. Data were analyzed with the RevMan 5.3 software program and evaluated with mean difference (MD), risk ratio (RR) and 95% confidence intervals (CIs) by random or fixed-effect models.
Sixteen RCTs involving 1,233 patients (1,486 hips) were included. Compared with CS, the incidence of thigh pain was significantly reduced with Proxima SS (RR 0.13, 95% CI, 0.03-0.51; P=0.004). Bone mineral density (BMD) with femoral neck-preserved SS [SS (I)] showed less decrease in Gruen zone 1 (MD 14.60, 95% CI, 10.67-18.54; P<0.00001) and Gruen zone 7 (MD 9.72, 95% CI, 5.21-14.23; P<0.0001) than CS. However, the changes of BMD were not significantly different between the SS without femoral neck preservation group [SS (II)] and the CS group. In addition, no significant differences were found in the revision rate, Harris Hip Score (HHS), or maximum total point motion (MTPM) between the SS and CS groups.
The results of this study showed that compared with CS, Proxima SS decreased the incidence of thigh pain and that SS (I) provided better proximal bone remodeling than CS. But the revision rates, HHS, and MTPM between SS and CS were similar. However, the findings of this meta-analysis require further verification in high-quality RCTs.
在全髋关节置换术（THA）中，短柄假体（SS）的设计目的是比传统柄假体（CS）更好地保留股骨近端骨量并提高稳定性，然而这些效果存在争议。我们旨在进行一项系统评价和荟萃分析，以评估SS和CS在初次THA中的有效性。
使用电子数据库PubMed、Embase和Web of Science筛选涉及初次THA中SS与CS比较的相关随机对照试验（RCT）。数据采用RevMan 5.3软件程序进行分析，并通过随机或固定效应模型以平均差（MD）、风险比（RR）和95%置信区间（CI）进行评估。
纳入了16项RCT，涉及1233例患者（1486髋）。与CS相比，使用Proxima SS时大腿疼痛的发生率显著降低（RR 0.13，95%CI，0.03 - 0.51；P = 0.004）。保留股骨颈的SS[SS（I）]组在Gruen 1区（MD 14.60，95%CI，10.67 - 18.54；P < 0.00001）和Gruen 7区（MD 9.72，95%CI，5.21 - 14.23；P < 0.0001）的骨密度（BMD）下降幅度小于CS组。然而，未保留股骨颈的SS组[SS（II）]与CS组之间的BMD变化无显著差异。此外，SS组和CS组在翻修率、Harris髋关节评分（HHS）或最大总活动度（MTPM）方面未发现显著差异。
本研究结果表明，与CS相比，Proxima SS降低了大腿疼痛的发生率，且SS（I）比CS能提供更好的近端骨重塑。但SS和CS之间的翻修率、HHS和MTPM相似。然而，该荟萃分析的结果需要在高质量的RCT中进一步验证。
