{"title":"Efficacy and safety of modular versus monoblock stems in revision total hip arthroplasty: a systematic review and meta-analysis.","authors":"Daofeng Wang, Hua Li, Wupeng Zhang, Huanyu Li, Cheng Xu, Wanheng Liu, Jiantao Li","doi":"10.1186/s10195-023-00731-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Both modular and monoblock tapered fluted titanium (TFT) stems are increasingly being used for revision total hip arthroplasty (rTHA). However, the differences between the two designs in clinical outcomes and complications are not yet clear. Here, we intend to compare the efficacy and safety of modular versus monoblock TFT stems in rTHA.</p><p><strong>Methods: </strong>PubMed, Embase, Web of Science, and Cochrane Library databases were searched to include studies comparing modular and monoblock implants in rTHA. Data on the survivorship of stems, postoperative hip function, and complications were extracted following inclusion criteria. Inverse variance and Mantel-Haenszel methods in Review Manager (version 5.3 from Cochrane Collaboration) were used to evaluate differences between the two groups.</p><p><strong>Results: </strong>Ten studies with a total of 2188 hips (1430 modular and 758 monoblock stems) were finally included. The main reason for the revision was aseptic loosening. Paprosky type III was the most common type in both groups. Both stems showed similar re-revision rates (modular vs monoblock: 10.3% vs 9.5%, P = 0.80) and Harris Hip Scores (WMD = 0.43, P = 0.46) for hip function. The intraoperative fracture rate was 11.6% and 5.0% (P = 0.0004) for modular and monoblock stems, respectively. The rate of subsidence > 10 mm was significantly higher in the monoblock group (4.5% vs 1.0%, P = 0.003). The application of extended trochanteric osteotomy was more popular in monoblock stems (22.7% vs 17.5%, P = 0.003). The incidence of postoperative complications such as periprosthetic femoral fracture and dislocation was similar between both stems.</p><p><strong>Conclusions: </strong>No significant difference was found between modular and monoblock tapered stems as regards postoperative hip function, re-revision rates, and complications. Severe subsidence was more frequent in monoblock stems while modular ones were at higher risk of intraoperative fracture.</p><p><strong>Level of evidence: </strong>Level III, systematic review of randomized control and non-randomized studies.</p><p><strong>Trial registration: </strong>We registered our study in the international prospective register of systematic reviews (PROSPERO) (CRD42020213642).</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":null,"pages":null},"PeriodicalIF":3.0000,"publicationDate":"2023-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10505121/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedics and Traumatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s10195-023-00731-5","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Both modular and monoblock tapered fluted titanium (TFT) stems are increasingly being used for revision total hip arthroplasty (rTHA). However, the differences between the two designs in clinical outcomes and complications are not yet clear. Here, we intend to compare the efficacy and safety of modular versus monoblock TFT stems in rTHA.
Methods: PubMed, Embase, Web of Science, and Cochrane Library databases were searched to include studies comparing modular and monoblock implants in rTHA. Data on the survivorship of stems, postoperative hip function, and complications were extracted following inclusion criteria. Inverse variance and Mantel-Haenszel methods in Review Manager (version 5.3 from Cochrane Collaboration) were used to evaluate differences between the two groups.
Results: Ten studies with a total of 2188 hips (1430 modular and 758 monoblock stems) were finally included. The main reason for the revision was aseptic loosening. Paprosky type III was the most common type in both groups. Both stems showed similar re-revision rates (modular vs monoblock: 10.3% vs 9.5%, P = 0.80) and Harris Hip Scores (WMD = 0.43, P = 0.46) for hip function. The intraoperative fracture rate was 11.6% and 5.0% (P = 0.0004) for modular and monoblock stems, respectively. The rate of subsidence > 10 mm was significantly higher in the monoblock group (4.5% vs 1.0%, P = 0.003). The application of extended trochanteric osteotomy was more popular in monoblock stems (22.7% vs 17.5%, P = 0.003). The incidence of postoperative complications such as periprosthetic femoral fracture and dislocation was similar between both stems.
Conclusions: No significant difference was found between modular and monoblock tapered stems as regards postoperative hip function, re-revision rates, and complications. Severe subsidence was more frequent in monoblock stems while modular ones were at higher risk of intraoperative fracture.
Level of evidence: Level III, systematic review of randomized control and non-randomized studies.
Trial registration: We registered our study in the international prospective register of systematic reviews (PROSPERO) (CRD42020213642).
背景:模块化和单块锥形凹槽钛(TFT)柄越来越多地用于翻修全髋关节置换术(rTHA)。然而，两种设计在临床结果和并发症方面的差异尚不清楚。在这里，我们打算比较模块化与单块TFT系统在rTHA中的有效性和安全性。方法:检索PubMed、Embase、Web of Science和Cochrane Library数据库，包括比较rTHA中模块化植入物和单块植入物的研究。根据纳入标准提取茎的存活率、术后髋关节功能和并发症的数据。使用Review Manager (Cochrane Collaboration版本5.3)中的逆方差和Mantel-Haenszel方法来评估两组之间的差异。结果:最终纳入了10项研究，共2188个髋关节(1430个模块和758个单块茎)。修改的主要原因是无菌性松动。两组患者中最常见的是papprosky III型。两种支架在髋关节功能方面显示相似的再翻修率(模块化vs单块:10.3% vs 9.5%， P = 0.80)和Harris髋关节评分(WMD = 0.43, P = 0.46)。模组骨折率为11.6%，单块骨折率为5.0% (P = 0.0004)。单块组沉降bbb10 mm的速率显著高于对照组(4.5% vs 1.0%， P = 0.003)。扩展粗隆截骨术在单块骨柄中应用更为普遍(22.7% vs 17.5%， P = 0.003)。术后并发症如假体周围股骨骨折和脱位的发生率在两茎之间相似。结论:在术后髋关节功能、再翻修率和并发症方面，模块化和单块锥形柄无显著差异。严重的下陷在单块柄中更常见，而模块化柄在术中骨折的风险更高。证据等级:III级，随机对照和非随机研究的系统评价。试验注册:我们在国际前瞻性系统评价注册(PROSPERO) (CRD42020213642)中注册了我们的研究。
期刊介绍：
The Journal of Orthopaedics and Traumatology, the official open access peer-reviewed journal of the Italian Society of Orthopaedics and Traumatology, publishes original papers reporting basic or clinical research in the field of orthopaedic and traumatologic surgery, as well as systematic reviews, brief communications, case reports and letters to the Editor. Narrative instructional reviews and commentaries to original articles may be commissioned by Editors from eminent colleagues. The Journal of Orthopaedics and Traumatology aims to be an international forum for the communication and exchange of ideas concerning the various aspects of orthopaedics and musculoskeletal trauma.
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