Saracco Michela, Ciriello Vincenzo, Fidanza Andrea, Logroscino Giandomenico
Department of Orthopaedics and Trauma, "San Giovanni di Dio" Hospital, ASL Napoli 2 Nord, Naples, Italy.
Department of Orthopaedics and Trauma, ASO "S. Croce e Carle", Cuneo, Italy.
Ann Jt. 2023 Nov 25;9:1. doi: 10.21037/aoj-23-32. eCollection 2024.
Increasingly hip replacements at young age exposes the patient to an increased risk of failure of the implant over the years. In case of failure, revision specific stems were designed to overcome bone loss. Modularity of these devices is an important resource for the surgeon as they allow the new implant to be better adapted to the patient's anatomy. The purpose of this systematic review is to provide data about the outcome at long-term follow-up (>8 years) of hip modular revision femoral stems.
This systematic review and meta-analysis were conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines. PubMed and Google Scholar databases were systematically and independently searched, according to the inclusion and exclusion criteria. Two reviewers performed the data extraction independently. In case of disagreement, the senior authors were sought to resolve the divergences. Quality of the involved studies was evaluated with National Institute for Health and Care Excellence (NICE) guidelines (eight-item list) and the Newcastle-Ottawa scale (NOS). Primary and secondary outcomes were evaluated. The statistical analysis of this meta-analysis was performed by using Excel Microsoft and the software STATA.
The primary outcome was the re-revision rate of modular revision stems at long-term follow-up. It ranged from 1.4% to 45.6%: random effect pooled estimate was 5.5% [95% confidence interval (CI): 4% to 7%], with a I of 12.3% (P=0.332). Mean Harris Hip Score (HHS) was 83 [min: 79; max: 87.6; standard deviation (SD): 3.55]. Secondary evaluated outcomes were: subsidence >5 mm, rate of periprosthetic infection or fractures (intra- and post-operative) and dislocations. The mean value for the NICE tool was 5.5 (SD: 1.13) and 7.3 (SD: 0.79) for the NOS tool. The survival rate was >90% at long-term follow-up (min: 60%; max: 97%).
The modular femoral revision stems have demonstrated good long-term reliability and efficacy. This meta-analysis demonstrates that the re-revision rate after 8 years of follow-up is low and 90% of the implants did not fail.
近年来，越来越多的年轻患者接受髋关节置换手术，这使得患者面临着植入物多年后失效风险增加的问题。一旦出现失效情况，专门设计的翻修柄旨在克服骨量流失。这些装置的模块化对外科医生来说是一项重要资源，因为它们能使新植入物更好地适应患者的解剖结构。本系统评价的目的是提供有关髋关节模块化翻修股骨柄长期随访（>8年）结果的数据。
本系统评价和荟萃分析按照PRISMA（系统评价和荟萃分析的首选报告项目）声明指南进行。根据纳入和排除标准，对PubMed和谷歌学术数据库进行了系统且独立的检索。两名评价者独立进行数据提取。如有分歧，寻求资深作者解决分歧。使用英国国家卫生与临床优化研究所（NICE）指南（八项清单）和纽卡斯尔-渥太华量表（NOS）评估所纳入研究的质量。对主要和次要结局进行了评估。本荟萃分析的统计分析使用Excel Microsoft和STATA软件进行。
主要结局是模块化翻修柄在长期随访时的再次翻修率。其范围为1.4%至45.6%：随机效应合并估计值为5.5%[95%置信区间（CI）：4%至7%]，I²为12.3%（P = 0.332）。平均Harris髋关节评分（HHS）为83[最小值：79；最大值：87.6；标准差（SD）：3.55]。次要评估结局包括：下沉>5 mm、假体周围感染或骨折（术中及术后）发生率以及脱位情况。NICE工具的平均值为5.5（SD：1.13），NOS工具的平均值为7.3（SD：0.79）。长期随访时生存率>90%（最小值：60%；最大值：97%）。
模块化股骨翻修柄已证明具有良好的长期可靠性和有效性。本荟萃分析表明，随访8年后的再次翻修率较低，90% 的植入物未出现失效情况。
