Le polyéthylène hautement réticulé diminue-t-il le taux de reprise des prothèses totales de hanche par rapport au polyéthylène conventionnel : une méta-analyse - 29/10/14
Does cross-linked polyethylene decrease the revision rate of total hip arthroplasty compared with conventional polyethylene? A meta-analysis
, Z.-H. Tang, J.-Z. Hu, G.-Y. Zou, R.-C. Xiao, D.-X. YanAbstract |
Background |
Although cross-linked polyethylene is resistant to wear in comparison to conventional polyethylene, it remains unknown whether it can decrease the wear-related revision rate of total hip arthroplasty.
Objectives |
To determine whether cross-linked polyethylene decreases the wear-related revision rate of total hip arthroplasty compared with conventional polyethylene.
Data sources |
Electronic databases, including PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials, were queried from inception to July 6, 2013.
Study selection |
Randomized controlled trials (RCTs) comparing cross-linked polyethylene with conventional polyethylene were included. In addition, the standard 28-mm femoral head was used, and follow-up was performed for a minimum of 5 years. The primary outcome assessed was wear-related revision. The secondary outcome measures evaluated were the incidence of osteolysis, the linear wear rate, and the linear head penetration.
Data synthesis |
The Cochrane Collaboration's tool for assessing the risk of bias was used for quality assessment. Data from eligible studies were pooled using a random effect model.
Results |
Eight studies involving 735 patients were included in this study. Meta-analysis showed there was no significant difference between cross-linked and conventional polyethylene group in terms of osteolysis or wear-related revision. The pooled mean differences were significantly less for the linear wear rate and linear head penetration for cross-linked polyethylene than for conventional polyethylene.
Limitations |
The studies differed with respect to the cross-linked liner brands, manufacturing processes, and radiological evaluation methods. Moreover, the follow-up periods of the RCTs were not long enough.
Conclusions |
The current limited evidence suggests that cross-linked polyethylene significantly reduced the radiological wear compared with conventional polyethylene at midterm follow-up periods. However, there is no evidence that cross-linked polyethylene had an advantage over conventional polyethylene in terms of reducing osteolysis or wear-related revision. Nevertheless, future long-term RCTs on this topic are needed.
Key findings |
Cross-linked polyethylene significantly reduced radiological wear but not osteolysis or wear-related revision in comparison to conventional polyethylene at midterm follow-up periods. Registration number: no.
Level of evidence |
I. Systematic review of level I studies.
Le texte complet de cet article est disponible en PDF.Keywords : Total hip arthroplasty, Polyethylene, Cross-linked, Meta-analysis
| ☆ | Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus. |
Vol 100 - N° 7
P. 536 - novembre 2014 Retour au numéro
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