Abstracto

Systematic review and meta-analysis of short stem versus long stem hip arthroplasty in osteonecrosis

Chang-Lu Liu, Xiao-Min Liu, Hui-Juan Nie

Objective: The aim of this study was to evaluate the efficacy and safety of short stem and long stem hip arthroplasty.

Design: A systemic review and meta-analysis.

Data sources: Randomized Controlled Trials (RCTs) comparing short stem with long stem were derived from the databases (PubMed, Embese, Google, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library and ISI Web of knowledge).

Outcome measures: Primary end points were thigh pain, radiographs and the quality of life; and the secondary end point was the adverse events.

Results: A total of 9 Randomized Controlled Trials (RCTs) were performed according to strict eligibility criteria. We enrolled 747 patients, with 364 patients randomized to short stem and 383 patients randomized to standard stem. Separate clinical and radiological outcome analyses were based on different follow-up periods. HHS (Harris Hip Scores) were significantly different in both of the two follow-ups (the short time: MD: 5.74, 95% CI 3.20 to 8.27 and the mid-long time: MD: 4.16, 95% CI 2.36 to 5.97). Significant differences were also observed in WOMAN scores (MD: 10.37, 95% CI 5.71 to 15.03), and pain scores (MD: 0.54, 95% CI 0.18 to 0.90). However, no differences were found in BMD (Bone mineral density) in the both of the two follow-ups (the short time: MD: -0.02, 95% CI -0.08 to 0.03 and the mid-long time: MD: -0.10, 95% CI -0.16 to -0.04), and in adverse complications (OR: 0.40, 95% CI 0.13 to 1.22).

Conclusions: The use of short stem significantly reduced pain intensity. In the follow-ups, Harris Hip Scores and WOMAN Scores significantly increased. However, the BMD and complications remain unclear due to little evidence.