Summary of findings for the main comparison. Uncemented fixation with and without hydroxyapatite compared to cemented fixation for osteoarthritis and other non‐traumatic diseases.
| Uncemented fixation with and without hydroxyapatite compared to cemented fixation for osteoarthritis and other non‐traumatic diseases | ||||||
| Patient or population: Patients with osteoarthritis and other non‐traumatic diseases Settings: Osteoarthritis (non‐post‐traumatic patients) Intervention: Uncemented with and without hydroxyapatite Comparison: Cemented | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Cemented | Uncemented with and without hydroxyapatite | |||||
|
Arthroplasty instability ‐ inferred from roentgen stereophotogrammetric analysis (Available data analysis) Follow‐up: 1 to 2 years |
287 per 1000 | 135 per 1000 (69 to 264) | RR 0.47 (0.24 to 0.92) | 216 (3 studies) | ⊕⊕⊕ moderate1 | Arthroplasty instability was considered an event. This outcome predicts knee arthroplasty revision rates because of aseptic loosening (provides indirect evidence). Absolute risk difference = 16% (95% CI ‐0.27 to ‐0.05) Relative percent change = 53% (95% CI 8 to 76%) NNTH = 7 (95% CI 5 to 44) |
| Survival rate of the implant (any change of a component) | See comment | See comment | 0 (0) | See comment | Survival rate of the implant is a long term outcome not available in included studies (2 to 5 year follow‐up). | |
| Global Assessment (Patient) | See comment | See comment | 27 (1) | See comment | Toksvig‐Larsen 1988 reported that all of the patients were satisfied with the results at a 2 year follow‐up. We found no mention of degrees of satisfaction. | |
| Functional measures with validated instruments | See comment | See comment | 240 (4) | See comment | Knee Society and HSS knee scores were recorded. The SD of the mean of the results was not reported. The authors found no significant difference between the groups. | |
| Pain | See comment | See comment | 0 (0) | See comment | Not reported. | |
| Health‐related quality of life measures | See comment | See comment | 0 (0) | See comment | Not reported. | |
| Total adverse event | See comment | See comment | 0 (0) | See comment | No evidence available2 | |
| *The basis for the assumed risk (e.g. the median control group risk among studies) is provided in the footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). 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. | ||||||
1 Roentgen stereophotogrammetric analysis predicts the arthroplasty instability. We downgraded for indirectness of evidence.
2The type of fixation of the femoral component was different from the tibial component in 3 out of 4 studies. It was not possible to correlate some adverse events to the cementation of the arthroplasty from the study description even when the type of fixation of the femoral and tibial components was the same (Nilsson 1999).