Cemented versus uncemented stems for revision total hip replacement: A systematic review and meta-analysis

Table 1 Newcastle-Ottawa Scale for assessing the quality of observational studies

Ref.	Selection				Comparability	Exposure			Total
	Representativeness of the exposed cohort	Selection of the non-exposed cohort	Ascertainment of exposure	Demonstration that outcome of interest was not present at start of study	Comparability of cohorts on the basis of the design or analysis	Assessment of outcome	Was follow-up long enough for outcomes to occur	Adequacy of follow up of cohorts	Total number of stars
Tyson et al[39], 2021	*	*	*	*	**	*	*	*	9
Weiss et al[38], 2011	*	*	*	*	*	*	*	*	8
Iorio et al[6], 2008	*	*	-	*	*	*	*	*	7

Table 2 Study characteristics

Ref.	Country	Journal	Study type	Centres	Level of evidence	Number of stems	Stem brand for cemented	Stem brand for uncemented
Tyson et al[39], 2021	Sweden	Acta Orthopaedica	Observational study	Multi	III	266 cemented, 601 uncemented	Lubinus SPII 123 (46%), exeter 94 (35%), spectron 49 (18%)	MP 291 (48%), restoration 162 (27%), wagner 78 (13%), revitan 70 (12%)
Weiss et al[38], 2011	Sweden	Acta Orthopaedica	Observational study	Multi	III	1073 cemented, 812 uncemented	Lubinus SPII 610 (57%), exeter long stem 248 (23%), spectron revision hip system 215 (20%)	MP stem 812 (100%)
Iorio et al[6], 2008	United States	Journal of arthroplasty	Prospective cohort study	Single	II	43 cemented, 43 uncemented	13 premise, 6 precision, 5 reliance (stryker), 3 re cemented, 2 charnley elite plus, 2 ultima, 1 PFC (depuy), 4 calcar replacing, 7 extra long	S-ROM modular metaphyseal femoral stem 31 (72%), calcar replacing 9 (23%), extra long 3 (7.7%)

Study characteristic for the studies included in the MA.

Table 3 Patient’s demographics

Ref.	Gender M	Age (SD)	Follow up in years (SD)
Tyson et al[39], 2021	Uncemented 318 (53%), cemented 138 (52%)	Uncemented 72 (10), cemented 74 (9)	Uncemented 4 (3), cemented 5 (3)
Weiss et al[38], 2011	Uncemented 443 (55%), cemented 544 (51%)	Uncemented 72 (11), cemented 76 (9)	Uncemented 3.4 (2.9), cemented 4.2 (2.5)
Iorio et al[6], 2008	22 cemented (51%), 22 uncemented (51%)	Uncemented 71.2 (9), cemented 67.5 (10)	Uncemented 7 (1), cemented 9 (1.5)

SD: Standard deviation.

Table 4 Study characteristics for the studies about the uncemented stem

Ref.	Total number	Country	Journal	Study type	Centres	Level of evidence
Mahoney et al[20], 2010	40	United States	JOA	ORS	Single	3
Hasegawa et al[22], 2021	45	Japan	International Orthopaedics	ORS	Single	3
Zheng et al[23], 2021	34	China	OSJ	ORS	Single	3
Wallace et al[24], 2020	55	United Kingdom	J Arthroplasty	ORS	Single	3
Zang et al[25], 2019	40	China/Japan	JOS (Hong Kong)	ORS	Single	3
Herry et al[26], 2019	116	Multi	International Orthopaedics	ORS	Multi	3
Shen et al[27], 2014	34	China	COAJ	ORS	Single	3
Wang et al[28], 2020	73	China	Hip International	ORS	Single	3
Singh et al[34], 2013	53	India	IJO	ORS	Single	3
Tsukeoka et al[41], 2011	14	Japan	Modern Rheumatology	ORS	Single	3
Oetgen et al[29], 2008	28	United States	JOT	ORS	Single	3
Sotereanos et al[36], 2006	16	United States	JBJS	ORS	Single	3
Philippot et al[35], 2009	43	France	OTSR	ORS	Single	3
Thorey et al[30], 2008	79	Germany	AOTS	ORS	Single	3
Malkani et al[31], 1996	74	United States	JOA	ORS	Single	3
Mulliken et al[32], 1996	66	Canada	CORR	ORS	Single	3
Meding et al[33], 1994	24	United States	JOA	ORS	Single	3

ORS: Observational retrospective study; JOA: The Journal of Arthroplasty; OSJ: Orthopaedic Surgery Journal; CORR: Clinical Orthopaedics and Related Research; AOTS: Archives of Orthopaedic and Trauma Surgery; OTSR: Orthopaedics & Traumatology, Surgery & Research; JBJS: Journal of Bone & Joint Surgery; JOT: Journal of Orthopaedics & Traumatology; IJO: Indian Journal of Orthopaedics; OSJ: Orthopaedic Surgery Journal; CJRRS: Chinese Journal of Reparative & Reconstructive Surgery; JOS: Journal of Orthopaedic Surgery (Hong Kong); COAJ: Chinese Orthopaedic Association Journal.

Table 5 Patients demographic for the study involved uncemented stem

Ref.	Gender male/female	Age in years (SD)	Follow up in years (SD)
Mahoney et al[20], 2010	18/22	64 (30.5)	10.2 (2.8)
Zhao et al[21], 2009	12/8	65 (9.5)	3 (1.1)
Hasegawa et al[22], 2021	12/33	62.6 (26)	13.8 (2.2)
Zheng et al[23], 2021	16/18	63.9 (11.7)	9.1 (2.5)
Wallace et al[24], 2020	19/36	66.4 (9.3)	13.2 (2.17)
Zang et al[25], 2019	15/25	62 (19.5)	15.7 (7.1)
Herry et al[26], 2019	55/61	68 (12)	10 (3)
Shen et al[27], 2014	21/13	65 (13.5)	6 (1.5)
Wang et al[28], 2020	33/42	62.6 (16.5)	12.6 (2)
Singh et al[34], 2013	42/6	54.7 (15.3)	14 (4.5)
Oetgen et al[29], 2008	18/10	59 (12)	5.5 (1.5)
Sotereanos et al[36], 2006	9/7	66 (17.5)	7.4 (6.5)
Philippot et al[35], 2009	10/33	54 (17.5)	5.3 (1.5)
Thorey et al[30], 2008	33/46	72.4 (28.5)	4 (2)
Malkani et al[31], 1996	40/ 34	67.1 (10.1)	6.8 (3.9)
Mulliken et al[32], 1996	31/32	62 (12)	3 (1)
Meding et al[33], 1994	17/7	63.8 (29)	3.6 (2)

SD: Standard deviation.

Table 6 Study characteristics of the cemented stem

Ref.	Country	Journal	Study type	Canters	Level of evidence	Total number	Gender male/female	Age	Follow up in years (SD)
Te Stroet et al[14], 2014	Netherlands	BJJ	ROS	Single centre	3	37	17/20	76 (39- 93)	9 (4)
Randhawa et al[15], 2009	United Kingdom	JOT	ROS	Single centre	3	57	27/30	73 (37-94)	3.25 (3)
Stigbrand and Ullmark, 2017	Sweden	JOA	ROS	Single centre	3	69	40/29	69	7 (3.2)
Pallaver et al[19], 2018	Switzerland	AOTS	ROS	Single	3	178	126/52	68.4 (36-90)	9.3 (5.2)
Davis et al[17], 2003	United States	JBJS	ROS	Single	3	48	27/21	67 (47-82)	6.5 (2)
Turner et al[18], 1987	United States	JOA	ROS	Single	3	165	81/84	62.1 (22-92)	6.7 (1.5)

ROS: Retrospective observational study; BJJ: The Bone & Joint Journal; MSM: Medical Science Monitor; JOT: Journal of Orthopaedics & Traumatology; JOA: Journal of Arthroplasty; AOTS: Archives of Orthopaedic and Trauma Surgery; JBJS: The Journal of Bone and Joint Surgery.

Table 7 Outcomes of the uncemented stem

Ref.	Intraoperative periprosthetic fracture (%)	Aseptic loosening (%)	Dislocation (%)	Infection (%)
Mahoney et al[20], 2010	1 (2.5)	1 (2.5)	13 (32.5)	1 (2.5)
Hasegawa et al[22], 2021	1 (2.2)	1 (2.2)	1 (2.2)	0 (0)
Zheng et al[23], 2021	7 (20.5)	3 (8.8)	1 (2.9)	3 (8.8)
Wallace et al[24], 2020	2 (3.6)	0 (0)	3 (5.4)	2 (3.6)
Zang et al[25], 2019	11 (27.5)	1 (2.5)	2 (5.0)	2 (5.0)
Herry et al[26], 2019	12 (10.3)	4 (3.4)	2 (1.7)	3 (2.5)
Shen et al[27], 2014	0 (0)	0 (0)	0 (0)	0 (0)
Tsukeoka et al[41], 2011	9 (64.2)	NA	1 (7.1)	NA
Wang et al[28], 2020	0 (0)	5 (6.8)	0 (0)	2 (2.7)
Singh et al[34], 2013	0 (0)	NA	3 (5.6)	7 (13.2)
Oetgen et al[29], 2008	3 (10.7)	0 (0)	0 (0)	NA
Sotereanos et al[36], 2006	NA	NA	0 (0)	0 (0)
Philippot et al[35], 2009	2 (4.6)	NA	1 (2.3)	3 (6.9)
Thorey et al[30], 2008	16 (20.2)	2 (2.5)	NA	2 (2.5)
Malkani et al[31], 1996	34 (45.9)	5 (6.75)	2 (2.7)	1 (1.3)
Mulliken et al[32], 1996	20 (30.3)	12(18.1)	NA	NA
Meding et al[33], 1994	4 (16.6)	0 (0)	3 (12.5)	1 (4.1)

NA: Not applicable.

Table 8 Outcomes of the cemented stem

Ref.	Periprosthetic fracture	Aseptic loosening	Dislocation	Infection
Te Stroet et al[14], 2014	9 (24.3)	0 (0)	3 (8.1)	4 (10.8)
Randhawa et al[15], 2009	4 (7.0)	1 (1.7)	1 (1.7)	7 (12.2)
Stigbrand and Ullmark, 2017	3 (4.3)	4 (5.7)	2 (2.8)	NA
Pallaver et al[19], 2018	2 (1.1)	3 (1.7)	NA	6 (3.3)
Davis et al[17], 2003	7 (14.5)	10 (20.8)	7 (14.5)	1 (2.0)
Turner et al[18], 1987	34 (20.6)	7 (4.2)	4 (2.4)	3 (1.8)

NA: Not applicable.