Department of Orthopedics, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.
Clinical Research Center, Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China.
Medicine (Baltimore). 2024 Sep 13;103(37):e39562. doi: 10.1097/MD.0000000000039562.
In patients undergoing hemiarthroplasty in the elderly, the choice of the cemented method remains controversial. This meta-analysis was undertaken to compare the impact of cemented vs uncemented on outcomes for hemiarthroplasty in the elderly.
This study included randomized controlled trials comparing the postoperative effects of cemented vs uncemented in patients with hemiarthroplasty. With no language restrictions, we searched Medline (Ovid), Embase (Ovid), Cochrane Central Register of Controlled Trials (Cochrane Collaboration), Clinical Trials.gov, the ISRCTN registry, as well as gray literature with no language restrictions from January 1966 to April 2023. Data were quantitatively summarized using a random-effects model. The primary outcome was 1-year mortality.
This study included 13 randomized controlled trials with 3485 patients. The primary outcomes of the meta-analysis showed that cemented fixation in elderly patients undergoing hemiarthroplasty was superior to noncemented in 1-year mortality (risk ratio [RR] = 0.87, 95% confidence interval [CI]: 0.77, 0.97). Moreover, cemented was associated with a reduced risk of intraoperative periprosthetic fracture (RR = 0.19, 95% CI: 0.07, 0.50), postoperative periprosthetic fracture (RR = 0.34, 95% CI: 0.16,0.72), and loosening (RR = 0.33, 95% CI: 0.11, 0.97).
Cemented hemiarthroplasty is superior to noncemented in terms of survival. Moreover, cementation reduces the incidence of some implant-related complications. More extensive trials are needed to provide adequate guidance for choosing the proper cemented method.
在老年患者行人工股骨头置换术中，骨水泥固定方法的选择仍存在争议。本荟萃分析旨在比较骨水泥固定与非骨水泥固定对老年人工股骨头置换术结局的影响。
本研究纳入了比较骨水泥固定与非骨水泥固定对人工股骨头置换术患者术后影响的随机对照试验。无语言限制，我们检索了 Medline（Ovid）、Embase（Ovid）、Cochrane 对照试验中心注册库（Cochrane 协作网）、ClinicalTrials.gov、ISRCTN 注册库以及无语言限制的灰色文献，检索时间截至 2023 年 4 月。使用随机效应模型对数据进行定量总结。主要结局为 1 年死亡率。
本研究纳入了 13 项随机对照试验，共 3485 例患者。荟萃分析的主要结局显示，在老年患者行人工股骨头置换术中，骨水泥固定优于非骨水泥固定，1 年死亡率更低（风险比 [RR] = 0.87，95%置信区间 [CI]：0.77，0.97）。此外，骨水泥固定与术中假体周围骨折（RR = 0.19，95% CI：0.07，0.50）、术后假体周围骨折（RR = 0.34，95% CI：0.16，0.72）和松动（RR = 0.33，95% CI：0.11，0.97）的风险降低相关。
在生存方面，骨水泥固定人工股骨头置换术优于非骨水泥固定。此外，骨水泥固定可降低一些与假体相关的并发症的发生率。需要更多的大规模试验为选择合适的骨水泥固定方法提供充分的指导。
