Risk Factors for Dislocation following Total Hip Arthroplasty in Developmental Dysplasia of the Hip: A Systematic Review and Meta-Analysis

Total Hip Arthroplasty in Patients Who Have Crowe Type IV Developmental Dysplasia of the Hip: A Systematic Review

BACKGROUND

Developmental dysplasia of the hip (DDH) is one of the principal causes of secondary hip osteoarthritis, giving rise to considerable pain, impaired mobility, and a reduced quality of life. The optimal approach to managing individuals who have Crowe-type IV DDH remains controversial. This study aimed to review the existing literature on the application of total hip arthroplasty (THA) as a treatment modality for Crowe-type IV DDH, assessing its efficacy in addressing this severe hip deformity.

METHODS

A comprehensive search across the PubMed, Scopus, and Web of Science databases identified relevant studies. Inclusion criteria encompassed investigations reporting outcomes of THA in Crowe-type IV DDH patients. Data extraction and quality assessment were performed independently by two reviewers. Utilizing R software, the prevalence of THA complications was analyzed through proportion analysis, employing the inverse variance method.

RESULTS

In this systematic review, a total of 74 studies were included, comprising a collective sample size of 2,829 patients (3,356 hips) diagnosed with Crowe-type IV DDH. The posterior/posterolateral approach was the most commonly utilized surgical approach, followed by the lateral Hardinge and direct lateral approaches. The majority of studies have employed subtrochanteric osteotomies. Notably, post-THA, leg length discrepancy (LLD) decreased, Trendelenburg sign resolved, and back pain reduced. Patient-reported outcome measures like the Harris Hip Score (HHS) improved significantly. The pooled prevalence rates of major postoperative complications were also assessed, including dislocation (7.2%), revision (8.7%), intraoperative fractures (10.5%), loosening (5.7%), nerve paralysis (5.6%), deep vein thrombosis (3.6%), infection (3.8%), heterotopic ossification grade 2 and above (6.1%), and a complicated patient rate of 11.0%.

CONCLUSION

Synthesizing diverse study data, an overview of THA's performance emerges, demonstrating significant enhancements in function, pain reduction, quality of life, and the correction of substantial LLD. While THA has shown positive outcomes, instances of complications have been reported. The decision to undergo THA should involve a collaborative assessment between the surgeon and the patient, considering potential benefits and complications.

The effect of intraoperative fluoroscopy on acetabular component positioning and patient anatomy restoration during posterior or posterolateral approach total hip arthroplasty: a meta-analysis

BACKGROUND

Positioning implant components and restoring patient anatomy during total hip arthroplasty (THA) are essential for joint stability, polyethylene liner wear, and range of motion. Previous studies comparing intraoperative fluoroscopy with no fluoroscopy during the posterior or posterolateral approach have reported conflicting results. This meta-analysis evaluated if intraoperative fluoroscopy improves component positioning and femoral component position compared to no fluoroscopy during posterior or posterolateral approach total hip arthroplasty.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were followed when conducting the systematic review. We searched Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database in May 2023 to identify studies involving Intraoperative fluoroscopy versus no fluoroscopy during posterior or posterolateral approach total hip arthroplasty. Finally, we identified 1133 patients (1145 hips) assessed in seven studies.

RESULTS

There were no significant differences in terms of acetabular cup inclination angle (ACIA, P = 0.43), ACIA within safe zone rate (P = 0.58), acetabular cup anteversion angle (ACAA, P = 0.46); ACAA within safe zone rate (P = 0.72), Combined safe zone rate (P = 0.28), dislocation rate (P = 0.64) and infection rate (P = 0.94) between two groups. Compared with the no fluoroscopy group, the intraoperative fluoroscopy group had more operation time (P < 0.00001), less femoral component offset difference (FCOD, P = 0.03), and less LLD (P < 0.00001).

CONCLUSION

Even though intraoperative fluoroscopy was not related to an improvement in cup location or dislocation incidence. Our findings demonstrate that the restoration of leg lengths and femoral offset can be significantly improved by using intraoperative fluoroscopy to supplement good surgical skills in THA. The advantages of intraoperative fluoroscopy might become more apparent for surgeons with less experience. To ascertain whether intraoperative fluoroscopy for posterior or posterolateral approach total hip arthroplasty will have clinical benefits and improve the survival of prostheses, more well-powered and well-designed long-term follow-up studies were necessary.