Issue |
SICOT-J
Volume 10, 2024
|
|
---|---|---|
Article Number | 25 | |
Number of page(s) | 14 | |
Section | Hip | |
DOI | https://doi.org/10.1051/sicotj/2024018 | |
Published online | 07 June 2024 |
Review Article
Do joint-preserving hip procedures compromise subsequent total hip arthroplasty? A meta-analysis of complications, functional outcome and survivorship
1
Oxford Trauma and Emergency Care, Nuffield Department of Orthopedics Rheumatology and Musculoskeletal Sciences, Kadoorie Centre, University of Oxford, Oxford OX3 9DU, United Kingdom
2
National Orthopedic Hospital Cappagh, Cappagh Road, Cappoge, Dublin 11 D11 EV29, Ireland
3
Department of Trauma and Orthopedics, Merlin Park Hospital, EC5, Old Dublin Road, Galway, Ireland
4
University College Dublin, School of Medicine, Belfield, Dublin 4, Ireland
* Corresponding author: ollieboughton@hotmail.com
Received:
15
February
2024
Accepted:
4
May
2024
Background: Joint-preserving hip operations can help relieve pain and delay the need for long-term joint arthroplasty. Previous research has not identified procedures that can compromise outcomes following total hip arthroplasty (THA). This meta-analysis aims to evaluate the effect of joint-preserving hip operations on outcomes following subsequent THA. Methods: MEDLINE, EMBASE and Scopus databases were searched from the date of inception until February 2024. All studies comparing outcomes following THA in individuals with (PS) and without prior surgery (NPS) of the femur or pelvis were included. Data on operative time, blood loss, intra- and post-operative complications, functional outcomes, and implant survivorship were extracted. Results: 16 studies, comprising 2576 patients were included (PS = 939, NPS = 1637). The PS group was associated with significantly longer operative time [MD: 8.1, 95% CI: 4.6–11.6], significantly greater blood loss [MD: 167.8, 95% CI: 135.6–200.0], and a higher risk of intra-operative peri-prosthetic fracture [RR: 1.9, 95% CI: 1.2–3.0], specifically, with prior femoral osteotomy. There were no differences in terms of risks of dislocation [RR: 1.8, 95% CI: 1.0–3.2], implant loosening [RR: 1.0, 95% CI: 0.7–1.5], or revision surgery [RR: 1.3, 95% CI: 1.0–1.7] between the two groups. The PS group was associated with significantly poorer improvements in functional outcome [MD: −5.6, 95% CI: −7.6–(−3.5)], specifically, with prior acetabular osteotomy. Implant survivorship in the two groups was comparable after one year [HR: 1.9, 95% CI: 0.6–6.2] but significantly inferior in the PS group after five years [HR: 2.5, 95% CI: 1.4–4.7], specifically, with prior femoral osteotomy. Conclusion: Joint-preserving hip operations are associated with greater intra-operative challenges and complications. In subsequent joint arthroplasty, prior acetabular procedures affect functional outcomes while prior femoral procedures influence implant survivorship. Hip pain due to the morphological sequelae of pediatric hip pathology can be debilitating at a young age. Surgical decision-making at that time needs to consider the survivorship of a THA implanted at that young age against the consequences of hip preservation surgery on further THA.
Key words: Osteotomy / Femoral / Acetabular / Hip preserving / Total hip arthroplasty
© The Authors, published by EDP Sciences, 2024
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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