title: Total hip replacement for the treatment of end stage arthritis of the hip: a systematic review and meta-analysis.
abstract: BACKGROUND
  Evolvements in the design, fixation methods, size, and bearing surface of implants for total hip replacement (THR) have led to a variety of options for healthcare professionals to consider. The need to determine the most optimal combinations of THR implant is warranted. This systematic review evaluated the clinical effectiveness of different types of THR used for the treatment of end stage arthritis of the hip.
  
  
  METHODS
  A comprehensive literature search was undertaken in major health databases. Randomised controlled trials (RCTs) and systematic reviews published from 2008 onwards comparing different types of primary THR in patients with end stage arthritis of the hip were included.
  
  
  RESULTS
  Fourteen RCTs and five systematic reviews were included. Patients experienced significant post-THR improvements in Harris Hip scores, but this did not differ between impact types. There was a reduced risk of implant dislocation after receiving a larger femoral head size (36 mm vs. 28 mm; RR = 0.17, 95% CI: 0.04, 0.78) or cemented cup (vs. cementless cup; pooled odds ratio: 0.34, 95% CI: 0.13, 0.89). Recipients of cross-linked vs. conventional polyethylene cup liners experienced reduced femoral head penetration and revision. There was no impact of femoral stem fixation and cup shell design on implant survival rates. Evidence on mortality and complications (aseptic loosening, femoral fracture) was inconclusive.
  
  
  CONCLUSIONS
  The majority of evidence was inconclusive due to poor reporting, missing data, or uncertainty in treatment estimates. The findings warrant cautious interpretation given the risk of bias (blinding, attrition), methodological limitations (small sample size, low event counts, short follow-up), and poor reporting. Long-term pragmatic RCTs are needed to allow for more definitive conclusions. Authors are encouraged to specify the minimal clinically important difference and power calculation for their primary outcome(s) as well CONSORT, PRISMA and STROBE guidelines to ensure better reporting and more reliable production and assessment of evidence.
authors.affiliation: Warwick Evidence, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, England.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tsertsvadze
authors.affiliation: Warwick Evidence, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, England.
authors.forename: Amy
authors.initials: A
authors.lastname: Grove
authors.affiliation: Warwick Evidence, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, England.
authors.forename: Karoline
authors.initials: K
authors.lastname: Freeman
authors.affiliation: Warwick Evidence, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, England.
authors.forename: Rachel
authors.initials: R
authors.lastname: Court
authors.affiliation: Warwick Evidence, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, England.
authors.forename: Samantha
authors.initials: S
authors.lastname: Johnson
authors.affiliation: Warwick Evidence, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, England.
authors.forename: Martin
authors.initials: M
authors.lastname: Connock
authors.affiliation: Warwick Evidence, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, England.
authors.forename: Aileen
authors.initials: A
authors.lastname: Clarke
authors.affiliation: Warwick Evidence, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, England.
authors.forename: Paul
authors.initials: P
authors.lastname: Sutcliffe
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D006801:Humans; D015207:Osteoarthritis, Hip / Q000601:surgery*; D058996:Quality Improvement; D016032:Randomized Controlled Trials as Topic; D012107:Research Design / Q000592:standards; D016896:Treatment Outcome