Koutserimpas Christos, Kotzias Dimitrios, Argyrou Alexandra, Veizi Enejd, Alpantaki Kalliopi, Karamitros Athanasios, Piagkou Maria
Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Greece.
Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Greece.
J Clin Orthop Trauma. 2024 Jul 4;54:102488. doi: 10.1016/j.jcot.2024.102488. eCollection 2024 Jul.
Threaded acetabular components (TACs) have been shown to offer greater initial stability compared to press-fit acetabular components (PFACs). Despite these biomechanical advantages, the use of threaded cups remains. This study compares the outcomes of TACs to PFACs in total hip arthroplasty (THA), providing evidence-based data regarding their failure rates and radiological evaluation.
A meticulous research of PubMed and MEDLINE databases, following the PRISMA guidelines, was conducted, to identify all articles regarding the outcome of the use of TCAs compared to PFACs in THA. Subsequently, statistical analysis with metanalysis concerning: 1) the instances of revision due to aseptic loosening and 2) the radiological evaluations of TACs compared to PFACs and sensitivity analysis were performed.
This metanalysis encompassed seven studies, enrolling 7878 cases of THA utilizing PFAC, and 6684 cases using TAC. The overall odds ratio (OR) for revision due to aseptic loosening in THA using PFAC compared to TAC was 3.10 (95 % CI 0.37-25.72). Additionally, when assessing radiolucency findings across the same categories, the pooled OR was 0.53 (95 % CI 0.26-1.08). An examination of studies with larger sample sizes revealed no statistically significant variance. After adjusting for age, no substantial difference was detected. However, upon gender adjustment, it was observed that females undergoing THA with PFAC had a 5-fold risk of revision (OR = 5.26, 95 % CI 0.25-111.91, p-value = 0.29) compared to females with TAC, although without reaching statistical significance. Moreover, females exhibited a slightly elevated risk for revision due to aseptic loosening post-PFAC THA compared to males [(OR = 5.26, 95 % CI 0.25-111.91) (OR = 2.51, 95 % CI 0.01-1051.68) respectively], and for radiolucency findings [(OR 0.74, 95 % CI 0.20-1.11) (OR 0.29, 95 % CI 0.03-3.36) respectively].
The PFACs remain the main option for total hip reconstruction, while TACs might be a viable alternative, especially in cases of osteoporosis.
与压配式髋臼组件（PFACs）相比，螺纹髋臼组件（TACs）已被证明能提供更高的初始稳定性。尽管有这些生物力学优势，但螺纹杯的使用情况仍然存在。本研究比较了全髋关节置换术（THA）中TACs与PFACs的疗效，提供了关于它们失败率和放射学评估的循证数据。
按照PRISMA指南对PubMed和MEDLINE数据库进行了细致研究，以识别所有关于THA中使用TCA与PFACs疗效比较的文章。随后，进行了荟萃分析的统计分析，涉及：1）因无菌性松动导致的翻修实例，以及2）TACs与PFACs的放射学评估，并进行了敏感性分析。
该荟萃分析纳入了7项研究，共7878例使用PFAC的THA病例和6684例使用TAC的病例。THA中使用PFAC与TAC相比，因无菌性松动导致翻修的总体比值比（OR）为3.10（95%CI 0.37 - 25.72）。此外，在评估同一类别的透光线结果时，合并后的OR为0.53（95%CI 0.26 - 1.08）。对样本量较大的研究进行检查发现无统计学显著差异。在调整年龄后，未检测到实质性差异。然而，在调整性别后，观察到接受PFAC的THA女性与接受TAC的女性相比，翻修风险高5倍（OR = 5.26，95%CI 0.25 - 111.91，p值 = 0.29），尽管未达到统计学显著性。此外，与男性相比，PFAC THA后女性因无菌性松动导致翻修的风险略有升高[分别为（OR = 5.26，95%CI 0.25 - 111.91）（OR = 2.51，95%CI 0.01 - 1051.68）]，对于透光线结果也是如此[分别为（OR 0.74，95%CI 0.20 - 1.11）（OR 0.29，95%CI 0.03 - 3.36）]。
PFACs仍然是全髋关节重建的主要选择，而TACs可能是一种可行的替代方案，尤其是在骨质疏松的病例中。
