Implante de Tântalo Poroso Preservador de Cabeça Femoral para Osteonecrose da Cabeça Femoral: Revisão Sistemática e Meta-Análise da Conversão para Artroplastia Total do Hip, Progressão Radiográfica e Modos de Falha

Resumo original em inglês

O que aconteceu

Porous tantalum implantation is a head-preserving alternative to core decompression in osteonecrosis of the femoral head. Reporting has declined in North America and Europe while continuing elsewhere; outcomes are discordant. Prior syntheses are dated and treated the two endpoints as interchangeable.

MEDLINE, Embase, Web of Science, and the Cochrane Library were searched to September 2025. Eligible studies reported head-preserving implantation in ≥5 hips followed ≥12 months, retrieval analyses excepted. The two endpoints were co-primary and pooled separately by random-effects Freeman-Tukey models with Hartung-Knapp adjustment.

O que encontraram

Twenty-two records (946 hips) contributed. Pooled conversion was 20.3% (95% CI 13.5-27.9; I2 = 78.8%; prediction interval 0.3-54.9). Eighteen records (729 hips) reported radiographic progression, pooled at 26.8% (95% CI 16.7-38.2), exceeding conversion within the cohort in twelve of sixteen records with matched denominators ( p = 0.003). Surgical technique was the only moderator associated with either outcome: rod alone versus an adjunctive procedure gave 27.2% versus 13.9% for conversion ( p = 0.028) and 37.4% versus 18.4% for progression ( p = 0.041), surviving adjustment for region but not removal of the one internally controlled cohort or alternative classification of three records. Region, stage, implant generation and follow-up showed no association. It persisted within a single staging system. Retrieval analyses showed minimal ingrowth into necrotic bone.

Por que isso importa

Roughly one hip in five proceeds to arthroplasty, and radiographic deterioration is more frequent. Dispersion may relate to whether a substrate for repair was supplied, not to geography or device, but that association is fragile and is offered as a hypothesis.

Resumo publicado sob licença CC BY. A tradução para o português ainda não chegou a este estudo.