Total hip arthroplasty after failed transtrochanteric rotational osteotomy forosteonecrosis of the femoral head: A systematic review and meta-analysis

摘要

Background. - Several studies have reported regarding total hip arthroplasty (THA) for osteonecrosisof the femoral head after failed transtrochanteric rotational osteotomy (TRO). However, to our know-ledge, no formal systematic review and meta-analysis have been published yet summarizing the clinicalresults of a THA after failed TRO. Therefore, we conducted a systematic review and meta-analysis of theTHA outcomes after failed TRO. We focussed on the issue whether a previous TRO affects the results ofsubsequent THA, including operative time, operative blood loss, radiological parameters, postoperativecomplications, and clinical outcomes. Methods. - Literatures published up to January 2018 were searched in the PubMed, Web of Science,and Cochrane Library, and the pooling of data was performed using a RevMan software (version 5.3,Cochrane Collaboration, Oxford, UK). A p-value < 0.05 was considered statistically significant. We cal-culated the mean differences (MD) for continuous data and the odds ratio (OR) for dichotomous datawith 95% confidence intervals (CI) for each outcome. Statistical heterogeneity was assessed based on I~2using the standard Chi~2 test. When I~2 > 50%, significant heterogeneity was assumed, and a random-effectsmodel was applied for the meta-analysis. A fixed-effects model was applied in the absence of significantheterogeneity. Results. - Five studies were included in this meta-analysis. The results showed that operative time wassignificantly longer in the THA after the TRO than that for the THA without previous osteotomy (I~2 = 92%;MD = 31.62; 95% CI: 5.95 to 57.28; p = 0.02). Operative blood loss was significantly greater in the THA afterthe TRO than that in the THA without previous osteotomy (I~2 = 71%; MD = 123.30; 95% CI: 22.21 to 224.39;p = 0.02). The rate of stem malalignment was significantly higher in the THA after the TRO than that inthe THA without previous osteotomy (I~2 = 0%; OR=5.23, 95% CI: 1.95 to 14.06; p = 0.001). There was nosignificant difference in the dislocation rate (I~2 = 0%; OR = 2.12; 95% CI: 0.64 to 6.99; p = 0.22), and thepostoperative Harris hip score at the final follow-up (I~2 = 75%, MD = -0.46,95% CI: -3.92 to 3.01, p = 0.80)between the groups. Conclusion. - The results demonstrate that, performing the THA after the TRO is technically more deman-ding than the THA without previous osteotomy. TRO does not affect the clinical results of future THA,and is a sufficient therapeutic alternative in younger patients.level of evidence. - III, systematic and meta-analysis of case control studies.