Effect of cementing technique on aseptic stem loosening in cemented primary total hip arthroplasty: a systematic review and meta-analysis

Background and objective: Aseptic stem loosening after total hip arthroplasty surgery is the commonest complication, whether stem is cemented or uncemented. The aseptic cemented stem loosening has been a challenging problem over the years and a leading cause for revision since the inception of total hip arthroplasty. The objective of systematic review and meta-analysis was to determine the impact of cementing technique on aseptic stem loosening in total hip arthroplasty. Methods: Cochrane, CINAHL, Embase, Google scholar, Medline, PubMed were searched in 13 December 2020. Two independent investigators extracted the data and a third investigator’s involvement was reached on consensus. A total of 37 studies of revision rate due to aseptic loosening were reviewed by using fixed/random effects size and were grouped by cementing technique and studies’ characteristics. The data were analyzed through Meta-Essentials and RStudio. Results: In revision total hip arthroplasty, retained femoral components revisions rate due to aseptic loosening were recorded in 37 studies involving 6167 cases. Aseptic loosening rate collectively was 5.8% (CI 95%, 0.03–0.08) and mean follow-up of study was 12.5 years. The average follow-up period, mean age at index revision surgery and percentage of aseptic loosening were insignificantly associated with revision rate (P≥0.05), in meta-regression univariant analyses. Conclusion: This investigative analysis showed that there is a minimal difference between results of cementing techniques of total hip arthroplasty in femoral components in long-term follow-ups, and usually have a low risk of failure.