Total hip replacement: A meta-analysis to evaluate survival of cemented, cementless and hybrid implants

Table 2 Summary of finding comparing cemented and cementless total hip replacement

	Illustrative comparative risks7 (95%CI)		Relative effect	No of participants	Quality of the evidence	Comments
	Assumed risk	Corresponding risk	(95%CI)	(studies)	(GRADE)
	Cementless	Cemented
Revision of any component due to any reason - RCT Follow-up: 14 to 19.5 yr	Study population		RR 1.43 (1 to 2.04)	452 (2 studies)	++-- low1,2
	165 per 1000	235 per 1000 (165 to 336)
	Moderate
	156 per 1000	223 per 1000 (156 to 318)
Revision of any component due to any reason - Register or Cohort of register Follow-up: 0 to 24 yr	Study population		RR 0.46 (0.45 to 0.47)	518774 (10 studies)	+--- very low2,3,4
	99 per 1000	46 per 1000 (45 to 47)
	Moderate
	122 per 1000	56 per 1000 (55 to 57)
Revision of any component due to any reason - All types of study Follow-up: 0 to 24 yr	Study population		RR 0.47 (0.45 to 0.48)	521757 (13 studies)	+--- very low2,3,5
	99 per 1000	46 per 1000 (44 to 47)
	Moderate
	106 per 1000	50 per 1000 (48 to 51)
Revision of any component due to aseptic loosening - RCT Follow-up: 14 to 19.5 yr	Study population		RR 2 (1.29 to 3.1)	452 (2 studies)	+++- moderate2
	104 per 1000	208 per 1000 (134 to 322)
	Moderate
	97 per 1000	194 per 1000 (125 to 301)
Revision of any component due to aseptic loosening - Register or Cohort of register Follow-up: 0 to 24 yr	Study population		RR 0.88 (0.83 to 0.94)	255779 (6 studies)	+--- very low2,3,4
	47 per 1000	41 per 1000 (39 to 44)
	Moderate
	48 per 1000	42 per 1000 (40 to 45)
Revision of any component due to aseptic loosening - All types of study Follow-up: 0 to 24 yr	Study population		RR 0.9 (0.84 to 0.95)	256231 (8 studies)	+--- very low2,3,5,6
	47 per 1000	43 per 1000 (40 to 45)
	Moderate
	48 per 1000	43 per 1000 (40 to 46)
Revision of any component due to infection - Register or Cohort of register Follow-up: 0 to 20 yr	Study population		RR 1.27 (1.04 to 1.55)	382433 (6 studies)	+--- very low2,4
	5 per 1000	6 per 1000 (5 to 7)
	Moderate
	4 per 1000	5 per 1000 (4 to 6)
Revision of any component due to infection - All types of study Follow-up: 0 to 20 yr	Study population		RR 1.29 (1.06 to 1.57)	382683 (7 studies)	+--- very low2,5
	5 per 1000	6 per 1000 (5 to 7)
	Moderate
	4 per 1000	5 per 1000 (4 to 6)
Dislocation of any component - Cohort Follow-up: 2.5 to 5 yr	Study population		RR 0.69 (0.29 to 1.67)	1066 (2 studies)	+--- very low1,2,3
	30 per 1000	21 per 1000 (9 to 50)
	Moderate
	30 per 1000	21 per 1000 (9 to 50)
Dislocation of any component - Register or Cohort of register Follow-up: 5 to 15 yr	Study population		RR 0.69 (0.59 to 0.8)	254786 (6 studies)	+--- very low3,4
	6 per 1000	4 per 1000 (4 to 5)
	Moderate
	13 per 1000	9 per 1000 (8 to 10)
Dislocation of any component - All types of study Follow-up: 2.5 to 15 yr	Study population		RR 0.69 (0.6 to 0.79)	255852 (8 studies)	+--- very low2,5
	6 per 1000	4 per 1000 (4 to 5)
	Moderate
	14 per 1000	10 per 1000 Ta(8 to 11)

CI: Confidence interval; RR: Risk ratio; GRADE Working Group grades of evidence; High quality: Further research is very unlikely to change our confidence in the estimate of effect; moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate; low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate; very low quality: We are very uncertain about the estimate.

¹95% confidence interval around the pooled or best estimate of effect includes both (1) no effect and (2) appreciable benefit or appreciable harm (> 25%);

²No explanation was provided;

³Unexplained heterogeneity;

⁴Indirect studies from registers;

⁵Overall result from all types of study;

⁶High heterogeneity, explained by meta-regression;

⁷The basis for the assumed risk (e.g., the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95%CI).