title: Total hip replacement: A meta-analysis to evaluate survival of cemented, cementless and hybrid implants.
abstract: OBJECTIVE
  To determine whether cemented, cementless, or hybrid implant was superior to the other in terms of survival rate.
  
  
  METHODS
  Systematic searches across MEDLINE, CINAHL, and Cochrane that compared cemented, cementless and hybrid total hip replacement (THR) were performed. Two independent reviewers evaluated the risk ratios of revision due to any cause, aseptic loosening, infection, and dislocation rate of each implants with a pre-determined form. The risk ratios were pooled separately for clinical trials, cohorts and registers before pooled altogether using fixed-effect model. Meta-regressions were performed to identify the source of heterogeneity. Funnel plots were analyzed.
  
  
  RESULTS
  Twenty-seven studies comprising 5 clinical trials, 9 cohorts, and 13 registers fulfilled the research criteria and analyzed. Compared to cementless THR, cemented THR have pooled RR of 0.47 (95%CI: 0.45-0.48), 0.9 (0.84-0.95), 1.29 (1.06-1.57) and 0.69 (0.6-0.79) for revision due to any reason, revision due to aseptic loosening, revision due to infection, and dislocation respectively. Compared to hybrid THR, the pooled RRs of cemented THR were 0.82 (0.76-0.89), 2.65 (1.14-6.17), 0.98 (0.7-1.38), and 0.67 (0.57-0.79) respectively. Compared to hybrid THR, cementless THR had RRs of 0.7 (0.65-0.75), 0.85 (0.49-1.5), 1.47 (0.93-2.34) and 1.13 (0.98-1.3).
  
  
  CONCLUSIONS
  Despite the limitations in this study, there was some tendency that cemented fixation was still superior than other types of fixation in terms of implant survival.
authors.affiliation: Phedy Phedy, Departement of Orthopaedic and Traumatology, Fatmawati General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta 12430, Indonesia.
authors.forename: Phedy
authors.initials: P
authors.lastname: Phedy
authors.affiliation: Phedy Phedy, Departement of Orthopaedic and Traumatology, Fatmawati General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta 12430, Indonesia.
authors.forename: H Dilogo
authors.initials: HD
authors.lastname: Ismail
authors.affiliation: Phedy Phedy, Departement of Orthopaedic and Traumatology, Fatmawati General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta 12430, Indonesia.
authors.forename: Charles
authors.initials: C
authors.lastname: Hoo
authors.affiliation: Phedy Phedy, Departement of Orthopaedic and Traumatology, Fatmawati General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta 12430, Indonesia.
authors.forename: Yoshi P
authors.initials: YP
authors.lastname: Djaja
keywords: Cemented; Cementless; Hybrid; Implant survival; Meta-analysis; Total hip replacement