Outcomes and metal ion levels of birmingham hip resurfacing versus total hip Arthroplasty: A systematic review and meta-analysis / 中国组织工程研究

ABSTRACT

BACKGROUND: Total hip arthroplasty is the gold standard for the end stage of elderly hip disease, but Birmingham hip resurfacing has become an effective alternative to total hip arthroplasty for young people with high levels of exercise. Whether Birmingham hip resurfacing has an advantage over total hip arthroplasty is still inconclusive. OBJECTIVE: To systematically review the efficacy and metal ion level of Birmingham hip resurfacing and total hip arthroplasty. METHODS: The electronic databases of PubMed, EMBASE, Cochrane library, and Web of Science, which last updated on November 30, 2018, were searched for clinical control study of Birmingham hip resurfacing and total hip arthroplasty. Literature data were extracted and literature quality was evaluated. Meta-analyses were performed with RevMan 5.3 software. RESULTS AND CONCLUSION: (1) Twelve studies were identified with a total of 2 317 patients (n=1 279 in Birmingham hip resurfacing group and n=1 038 in total hip arthroplasty group). (2) Meta-analysis results demonstrated that in the primary outcome measures, the Birmingham hip resurfacing group did not differ from the total hip arthroplasty group during short-term follow-up (RR=0.13, 95% CI [0.02, 1.01], P=0.05), but Birmingham hip resurfacing had a lower revision rate during long-term follow-up (RR=0.27, 95% CI [0.15, 0.50], P 0.05). (4) Finally, in the metal ion level, whether it was short-term follow-up or long-term follow-up, there was no significant difference between Birmingham hip resurfacing and total hip arthroplasty (P < 0.05). While at the Cr ion level, there was no significant difference between Birmingham hip resurfacing and total hip arthroplasty in short-term follow-up (P=0.55), but long-term follow-up showed that Birmingham hip resurfacing released more Cr ions than total hip arthroplasty after surgery, and the difference between the groups was statistically significant (P=0.03). (5) In conclusion, compared with total hip arthroplasty, Birmingham hip resurfacing has a smaller revision rate and overall complication, a better hip function score, but its Cr ion level is higher. This conclusion still needs further a great amount of large-sample, multi-center, high-quality randomized controlled trials to verify its correctness.