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

Abstract

Periprosthetic joint infection (PJI) is a rare but terrible complication in hip and knee arthroplasty, and the use of topical vancomycin powder (VP) has been investigated as a tool to potentially reduce its incidence. However, there remains no consensus on its efficacy. Therefore, the aim of this review is to provide an overview on the application of topical vancomycin in orthopaedic surgery focusing on the recent evidence and results in total joint arthroplasty. Several systematic reviews and meta-analyses on topical VP in hip and knee arthroplasty have been recently published reporting sometimes conflicting results. Apart from all being limited by the quality of the included studies (mostly level III and IV), confounding variables are often included potentially leading to biased conclusions. If taken into consideration the exclusive use of VP in isolation, the available data, although very limited, suggest that it does not reduce the infection rate in routine primary hip and knee arthroplasty. Therefore, we still cannot advise for a routinary application. A properly powered randomized-controlled trial would be necessary to clarify the role of VP in hip and knee arthroplasty. Based on the analysis of the current evidence, the use of topical VP appears to be safe when used locally in terms of systemic adverse reactions, hence, if proven to be effective, it could bring great benefits due to its low cost and accessibility.

The Use of Laboratory Criteria in the Risk Assessment of Postoperative Complications After Transpedicular Fixation of the Lumbar Spine

“…Найсерйознішим ускладненням ортопедичної хірургії є тромбоз глибоких вен, який спричинює легеневу тромбоемболію [16][17][18].…”

Cementless Primary Stems in Revision Hip Arthroplasty: A Narrative Review

“…Conservative strategies for femoral component revisions have been developed to be "as proximal as possible and as distal as necessary", with the aim to spare as much bone stock as possible for eventual future revisions, and to avoid intraoperative complications due to diaphysealengaging stems and distal bone stock violations [5,7]. While a primary cemented stem is a possible effective conservative solution in cases of previously cemented components (cement-in-cement) or minimal bone stock loss, cementless stem revisions have been gaining popularity and are generally preferred for their biological fixations and presumably better long-term outcomes, as well as surgeon preference [4,8]. There are two possible conservative options for cementless primary stems: conventional stems and short stems [5].…”

Radiological Comparison of Canal Fill between Collared and Non-Collared Femoral Stems: A Two-Year Follow-Up after Total Hip Arthroplasty

“…Uncemented stems in THA have become the dominant fixation strategy for individuals under the age of 75 due to their simple implantation, excellent stability, favorable clinical outcomes, and robust implant survival rates [11][12][13]. Nevertheless, apprehensions persist regarding the accuracy of the fit of uncemented stems within the proximal femoral canal, the reproducibility of the final seating height of the implant, and the likelihood of stem subsidence [14,15].…”