Fixation of Femoral Component in Hip Arthroplasty: A Systematic Review of Safety_Chinese Journal of Evidence-Based Medicine

Authors：

MA Jieke ¹ , PEI Fuxing ¹ , LI Youping ² , XIONG Ying ² , WEI Xin ³

1. Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu 610041, China 2. Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China 3. Peking Union Medical College, Beijing 100005, China;

Corresponding author：

Keywords：

Hip arthroplasty, Cement, Uncemented, Systematic review

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Objective 　Use the method of Cochrane systematic review to evaluate the difference of two fixation methods of femoral component in hip arthroplasty in order to choose the most appropriate fixation method.
Methods 　Searches was applied to the following electronic databases: Chinese Bimedical Database (CBM) (1979 to Dec. 2004), MEDLINE (1966 to Feb. 2005), EMBASE (1984 to 2004) and The Cochrane Library (Issue 4, 2004). We handsearched Chinese Journal of Orthopaedy, the Journal of Bone and Joint Injury and Orthopaedic Journal of China (from establishment to Feb. 2005). Randomized controlled trials (RCT) were indentified and we applied RevMan 4.2 for statistical analysis.
Results 　Nine RCTs involving 1 075 hips were included. The combined results of meta-analysis showed that the embolization occurred more commonly in the first and second generation cemented group (OR 0.02, 95%CI 0 to 0.11, P＜0.000 01), but this difference was not seen between the third generation cemented group and uncemented group (OR 0.80, 95%CI 0.36 to 1.78, P=0.58); The subsidence of femoral component (OR 12.20, 95%CI 3.58 to 41.54, P＜0.000 1) and the cortical hypertrophy (OR 69.97, 95%CI 27.88 to 175.57, P＜0.000 01) were more commonly found in uncemented group; the thigh pain occurrence, the revision for the femoral component’s cause and heterotopic ossification were found no significant difference in the two groups.
Conclusions 　Compared with noncemented group, we found that cemented fixation may be more associated with embolism in the first and second generation cemented technique and less with femoral subsidence and cortical hypertrophy. There was no significant difference in embolization between the third generation cemented technique group and noncemented group. However, more randomized controlled trials to evaluate the occurrence of the postoperative thigh pain, revision and heterotopic ossification are needed.

Citation： MA Jieke,PEI Fuxing,LI Youping,XIONG Ying,WEI Xin. Fixation of Femoral Component in Hip Arthroplasty: A Systematic Review of Safety. Chinese Journal of Evidence-Based Medicine, 2005, 05(4): 296-302. doi: Copy

1.	Alderson P, Green S, Higgins JPT, editors. Cochrane Reviewers Handbook 4.2.1 [updated December 2003] [M/CD]. Section 6. In: The Cochrane Library. The Cochrane Collaboration. Oxford: 2004, issue 1.
2.	Anders W, Elisabeth O, Gabriella A, Ian G. Total hip arthroplasty: a comparison between cemented and Press-fit noncemented fixation[J]. J Arthroplasty, 1991; 6(1): 19-29.
3.	Andreas L, Robert B, Cecil R, David F, Peter T, Cindy W. Comparison of Total Hip Arthroplasty performed with and without cement: a randomized trial[J]. J Bone Joint Surg Am, 2002; 84-A(10): 1 823-1 828.
4.	Astor R, Magne R, Kjell B, Merete B. Femoral remodeling after arthroplasty of the hip: TPospective randomized 5-year comparison of 120 cemented/uncemented cases of arthrosis[J]. Acta Orthop Scand, 1993; 64(4): 411-416.
5.	Christie J, Burnett R, Potts HR, Pell ACH. Echocardiography of transatrial embolism during cem and uncemented hemiarthroplasty of the hip[J]. J Bone Joint Surg Br, 1994; 76(3): 409-412.
6.	Godsiff SP, Emery RJ, Heywood MB, Thomas TL. Cemented versus uncemented femoral components in the ring hip TPosthesis[J]. J Bone Joint Surg Br, 1992; 74(6): 822-824.
7.	Johan K, Henrik M, Finnur S, Peter H. Micromotion of femoral stem in total hip arthroplasty: A randomized study of cemented, hydroxapatite-coated and porous-coated stems with roentgen sterophotogrammetri analysis[J]. Journ of Bone Joint Surg, 1994; 76(11): 1 692-1 705.
8.	Pitto RP, Koessler M, Joern WK. Comparison of fixation of the femoral component without cement and fixation with use of a bone-vacuum cementing technique for the prevention of fat embolism during THA[J]. J Bone Joint Surg Am, 1999; 81(6): 831-843.
9.	Rorabeck CH, Robert BB, Mulliken BD, Naresh N, Andereas L, Peter T, David F. The Nicloas Andry Award: Comparative results of cemented and cementless total hip arthroplasty[J]. Clinical Orthopaedics and Related Research, 1996; 325: 330-344.
10.	Young HK, S-W O, J-S K. Prevalence of fat embolism following bilateral simultaneous and unilateral THA performed with or without cement. A prospective randomized clinical study[J]. J Bone Joint Surg Am, 2002; 84-A(8): 1 372-1 379.
11.	Orsini EC, Byrick RJ, Mullen JB, Kay JC, Waddell JP.Cardiopulmonary function and pulmonary microemboli during arthroplasty using cemented or noncemented components. The role of intramedullary pressure[J]. J bone Joint Surg Am, 1987; 69: 822-832.
12.	Ries MD, Lynch F, Rauscher LA, Richman J, Mick C, Gomez M. Pulmonary function during and after total hip replacement. Findings in patients who have insertion of a femoral component with or without cement[J]. J Bone Joint Surg Am, 1993; 75(4): 581-587.
13.	Inadome T, Wall MC, Smith CL, Whiteside LA. Femoral intramedullary pressure during in vitro cemented and cementless total hip arthroplasty[J]. Orthop Trans, 1998-99; 22: 154-155.
14.	Hagio K, Sugano N, Masaki T, Takashi N, Hideki Y, Takahiro O. Embolic events during total hip arthroplasty: An echocardiographic study[J]. Journal of Arthroplasty, 2003; 18(2): 186-192.
15.	Weber BG. Pressurized cement fixation in total hip arthroplasty[J]. Clin Orthop Relat Res, 1988; 232: 87-95.
16.	Pitto RP, Koessler M, Draenert K. Prophylaxis of fat and bone marrow embolism in cemented total hip arthroplasty[J]. Clin Orthop, 1998; 355: 23-34.
17.	McGee MA, Howie DW, Neale SD, Haynes DR, Pearcy MJ. The role of polyethylene wear in joint replacement failure[J]. Proc Inst Mech Eng, 1997; 211(1): 65-72.
18.	Sylvain GM, Kassab S, Coutts R, Santore R. Early failure of a roughened surface, precoated femoral component in total hip arthroplasty[J]. J Arthroplasty, 2001; 16(2): 141-148.
19.	Mulliken BD, Nayak N, Bourne RB, Rorabeck CH, Bullas R. Early radiographic results comparing cemented and cementless THA[J]. J Arthroplasty, 1996; 11(1): 24-33.
20.	Karrholm J, Frech W, Snorrason F, Nilsson KG. Increased metal release from cemented femoral components. Evaluation of 19 hip TPotheses followed with stereoradiography[J]. Trans Orthop Res Soc, 1993; 18: 507.
21.	Mjoberg B, Selvic G, Hansson L, Rosenqvist R, Onnerfalt R. Mechanical loosening of total hip protheses: A radiographic and roentgen stereophotogrammetric study[J]. J Bone Joint Surg Br, 1986; 68-B(5): 770-774.
22.	Harris W H. Will stress-shielding limit the longevity of cemented femoral components of THR[J]? Clin Orthop, 1992; 274: 120-123.
23.	Huiskes R. The various stress patterns of Press-fit, ingrown, and cemented femoral stems[J]. Clin Orthop, 1990; 261: 27-38.
24.	Lintner F, Zweymuller K, Bohm G, Brand G. Reactions of surrounding tissue to the cementless hip implant Ti-6Al-4V after an implantation period of several years. Autopsy study in three cases[J]. Arch Orthop Trauma Surg, 1988; 107(6): 357-363.

1. Alderson P, Green S, Higgins JPT, editors. Cochrane Reviewers Handbook 4.2.1 [updated December 2003] [M/CD]. Section 6. In: The Cochrane Library. The Cochrane Collaboration. Oxford: 2004, issue 1.
2. Anders W, Elisabeth O, Gabriella A, Ian G. Total hip arthroplasty: a comparison between cemented and Press-fit noncemented fixation[J]. J Arthroplasty, 1991; 6(1): 19-29.
3. Andreas L, Robert B, Cecil R, David F, Peter T, Cindy W. Comparison of Total Hip Arthroplasty performed with and without cement: a randomized trial[J]. J Bone Joint Surg Am, 2002; 84-A(10): 1 823-1 828.
4. Astor R, Magne R, Kjell B, Merete B. Femoral remodeling after arthroplasty of the hip: TPospective randomized 5-year comparison of 120 cemented/uncemented cases of arthrosis[J]. Acta Orthop Scand, 1993; 64(4): 411-416.
5. Christie J, Burnett R, Potts HR, Pell ACH. Echocardiography of transatrial embolism during cem and uncemented hemiarthroplasty of the hip[J]. J Bone Joint Surg Br, 1994; 76(3): 409-412.
6. Godsiff SP, Emery RJ, Heywood MB, Thomas TL. Cemented versus uncemented femoral components in the ring hip TPosthesis[J]. J Bone Joint Surg Br, 1992; 74(6): 822-824.
7. Johan K, Henrik M, Finnur S, Peter H. Micromotion of femoral stem in total hip arthroplasty: A randomized study of cemented, hydroxapatite-coated and porous-coated stems with roentgen sterophotogrammetri analysis[J]. Journ of Bone Joint Surg, 1994; 76(11): 1 692-1 705.
8. Pitto RP, Koessler M, Joern WK. Comparison of fixation of the femoral component without cement and fixation with use of a bone-vacuum cementing technique for the prevention of fat embolism during THA[J]. J Bone Joint Surg Am, 1999; 81(6): 831-843.
9. Rorabeck CH, Robert BB, Mulliken BD, Naresh N, Andereas L, Peter T, David F. The Nicloas Andry Award: Comparative results of cemented and cementless total hip arthroplasty[J]. Clinical Orthopaedics and Related Research, 1996; 325: 330-344.
10. Young HK, S-W O, J-S K. Prevalence of fat embolism following bilateral simultaneous and unilateral THA performed with or without cement. A prospective randomized clinical study[J]. J Bone Joint Surg Am, 2002; 84-A(8): 1 372-1 379.
11. Orsini EC, Byrick RJ, Mullen JB, Kay JC, Waddell JP.Cardiopulmonary function and pulmonary microemboli during arthroplasty using cemented or noncemented components. The role of intramedullary pressure[J]. J bone Joint Surg Am, 1987; 69: 822-832.
12. Ries MD, Lynch F, Rauscher LA, Richman J, Mick C, Gomez M. Pulmonary function during and after total hip replacement. Findings in patients who have insertion of a femoral component with or without cement[J]. J Bone Joint Surg Am, 1993; 75(4): 581-587.
13. Inadome T, Wall MC, Smith CL, Whiteside LA. Femoral intramedullary pressure during in vitro cemented and cementless total hip arthroplasty[J]. Orthop Trans, 1998-99; 22: 154-155.
14. Hagio K, Sugano N, Masaki T, Takashi N, Hideki Y, Takahiro O. Embolic events during total hip arthroplasty: An echocardiographic study[J]. Journal of Arthroplasty, 2003; 18(2): 186-192.
15. Weber BG. Pressurized cement fixation in total hip arthroplasty[J]. Clin Orthop Relat Res, 1988; 232: 87-95.
16. Pitto RP, Koessler M, Draenert K. Prophylaxis of fat and bone marrow embolism in cemented total hip arthroplasty[J]. Clin Orthop, 1998; 355: 23-34.
17. McGee MA, Howie DW, Neale SD, Haynes DR, Pearcy MJ. The role of polyethylene wear in joint replacement failure[J]. Proc Inst Mech Eng, 1997; 211(1): 65-72.
18. Sylvain GM, Kassab S, Coutts R, Santore R. Early failure of a roughened surface, precoated femoral component in total hip arthroplasty[J]. J Arthroplasty, 2001; 16(2): 141-148.
19. Mulliken BD, Nayak N, Bourne RB, Rorabeck CH, Bullas R. Early radiographic results comparing cemented and cementless THA[J]. J Arthroplasty, 1996; 11(1): 24-33.
20. Karrholm J, Frech W, Snorrason F, Nilsson KG. Increased metal release from cemented femoral components. Evaluation of 19 hip TPotheses followed with stereoradiography[J]. Trans Orthop Res Soc, 1993; 18: 507.
21. Mjoberg B, Selvic G, Hansson L, Rosenqvist R, Onnerfalt R. Mechanical loosening of total hip protheses: A radiographic and roentgen stereophotogrammetric study[J]. J Bone Joint Surg Br, 1986; 68-B(5): 770-774.
22. Harris W H. Will stress-shielding limit the longevity of cemented femoral components of THR[J]? Clin Orthop, 1992; 274: 120-123.
23. Huiskes R. The various stress patterns of Press-fit, ingrown, and cemented femoral stems[J]. Clin Orthop, 1990; 261: 27-38.
24. Lintner F, Zweymuller K, Bohm G, Brand G. Reactions of surrounding tissue to the cementless hip implant Ti-6Al-4V after an implantation period of several years. Autopsy study in three cases[J]. Arch Orthop Trauma Surg, 1988; 107(6): 357-363.

Chinese Journal of Evidence-Based Medicine

Fixation of Femoral Component in Hip Arthroplasty: A Systematic Review of Safety

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