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.
95% confidence interval around the pooled or best estimate of effect includes both (1) no effect and (2) appreciable benefit or appreciable harm (> 25%);
No explanation was provided;
Unexplained heterogeneity;
Indirect studies from registers;
Overall result from all types of study;
High heterogeneity, explained by meta-regression;
The 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).