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Arthroplastie totale de hanche après ostéotomie de rotation trantrochantérienne pour nécrose de la tête fémorale : revue systématique et méta-analyse
Revue de chirurgie orthopédique et traumatologique 104 (2018) 779
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Arthroplastie totale de hanche après ostéotomie de rotation trantrochantérienne pour nécrose de la tête fémorale : revue systématique et méta-analyse夽 Total hip arthroplasty after failed transtrochanteric rotational osteotomy for osteonecrosis of the femoral head: A systematic review and meta-analysis Tomonori Shigemura a,∗ , Yohei Yamamoto a , Yasuaki Murata a , Takashi Sato a , Ryuto Tsuchiya a , Norichika Mizuki b , Yasunori Toki c , Yuichi Wada a a
Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba 299-0111, Japon Department of Orthopaedic Surgery, Chiba Rosai Hospital, 2-16 Tatsumidai-higashi, Ichihara„ Chiba 290-0003, Japon c Department of Orthopaedic Surgery, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu, Chiba 292-0822, Japon b
i n f o
a r t i c l e
Historique de l’article : ´ 2018 Rec¸u le 5 fevrier Accepté le 8 juin 2018 Keywords: Total hip arthroplasty Osteonecrosis Transtrochanteric rotational osteotomy Systematic review Meta-analysis
a b s t r a c t Background. – Several studies have reported regarding total hip arthroplasty (THA) for osteonecrosis of the femoral head after failed transtrochanteric rotational osteotomy (TRO). However, to our knowledge, no formal systematic review and meta-analysis have been published yet summarizing the clinical results of a THA after failed TRO. Therefore, we conducted a systematic review and meta-analysis of the THA outcomes after failed TRO. We focussed on the issue whether a previous TRO affects the results of subsequent THA, including operative time, operative blood loss, radiological parameters, postoperative complications, 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 calculated the mean differences (MD) for continuous data and the odds ratio (OR) for dichotomous data with 95% confidence intervals (CI) for each outcome. Statistical heterogeneity was assessed based on I2 using the standard Chi2 test. When I2 > 50%, significant heterogeneity was assumed, and a random-effects model was applied for the meta-analysis. A fixed-effects model was applied in the absence of significant heterogeneity. Results. – Five studies were included in this meta-analysis. The results showed that operative time was significantly longer in the THA after the TRO than that for the THA without previous osteotomy (I2 = 92%; MD = 31.62; 95% CI: 5.95 to 57.28; p = 0.02). Operative blood loss was significantly greater in the THA after the TRO than that in the THA without previous osteotomy (I2 = 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 in the THA without previous osteotomy (I2 = 0%; OR = 5.23, 95% CI: 1.95 to 14.06; p = 0.001). There was no significant difference in the dislocation rate (I2 = 0%; OR = 2.12; 95% CI: 0.64 to 6.99; p = 0.22), and the postoperative Harris hip score at the final follow-up (I2 = 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 demanding 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. © 2018 Elsevier Masson SAS. All rights reserved.
DOI de l’article original : https://doi.org/10.1016/j.otsr.2018.06.019. 夽 Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus. ∗ Auteur correspondant. Adresse e-mail : [email protected] (T. Shigemura). https://doi.org/10.1016/j.rcot.2018.09.123 ´ ´ 1877-0517/© 2018 Elsevier Masson SAS. Tous droits reserv es.
Disponible en ligne sur
ScienceDirect www.sciencedirect.com
Mise au point
Arthroplastie totale de hanche après ostéotomie de rotation trantrochantérienne pour nécrose de la tête fémorale : revue systématique et méta-analyse夽 Total hip arthroplasty after failed transtrochanteric rotational osteotomy for osteonecrosis of the femoral head: A systematic review and meta-analysis Tomonori Shigemura a,∗ , Yohei Yamamoto a , Yasuaki Murata a , Takashi Sato a , Ryuto Tsuchiya a , Norichika Mizuki b , Yasunori Toki c , Yuichi Wada a a
Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba 299-0111, Japon Department of Orthopaedic Surgery, Chiba Rosai Hospital, 2-16 Tatsumidai-higashi, Ichihara„ Chiba 290-0003, Japon c Department of Orthopaedic Surgery, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu, Chiba 292-0822, Japon b
i n f o
a r t i c l e
Historique de l’article : ´ 2018 Rec¸u le 5 fevrier Accepté le 8 juin 2018 Keywords: Total hip arthroplasty Osteonecrosis Transtrochanteric rotational osteotomy Systematic review Meta-analysis
a b s t r a c t Background. – Several studies have reported regarding total hip arthroplasty (THA) for osteonecrosis of the femoral head after failed transtrochanteric rotational osteotomy (TRO). However, to our knowledge, no formal systematic review and meta-analysis have been published yet summarizing the clinical results of a THA after failed TRO. Therefore, we conducted a systematic review and meta-analysis of the THA outcomes after failed TRO. We focussed on the issue whether a previous TRO affects the results of subsequent THA, including operative time, operative blood loss, radiological parameters, postoperative complications, 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 calculated the mean differences (MD) for continuous data and the odds ratio (OR) for dichotomous data with 95% confidence intervals (CI) for each outcome. Statistical heterogeneity was assessed based on I2 using the standard Chi2 test. When I2 > 50%, significant heterogeneity was assumed, and a random-effects model was applied for the meta-analysis. A fixed-effects model was applied in the absence of significant heterogeneity. Results. – Five studies were included in this meta-analysis. The results showed that operative time was significantly longer in the THA after the TRO than that for the THA without previous osteotomy (I2 = 92%; MD = 31.62; 95% CI: 5.95 to 57.28; p = 0.02). Operative blood loss was significantly greater in the THA after the TRO than that in the THA without previous osteotomy (I2 = 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 in the THA without previous osteotomy (I2 = 0%; OR = 5.23, 95% CI: 1.95 to 14.06; p = 0.001). There was no significant difference in the dislocation rate (I2 = 0%; OR = 2.12; 95% CI: 0.64 to 6.99; p = 0.22), and the postoperative Harris hip score at the final follow-up (I2 = 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 demanding 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. © 2018 Elsevier Masson SAS. All rights reserved.
DOI de l’article original : https://doi.org/10.1016/j.otsr.2018.06.019. 夽 Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus. ∗ Auteur correspondant. Adresse e-mail : [email protected] (T. Shigemura). https://doi.org/10.1016/j.rcot.2018.09.123 ´ ´ 1877-0517/© 2018 Elsevier Masson SAS. Tous droits reserv es.