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Does prior core decompression have detrimental effect on subsequent total hip arthroplasty for osteonecrosis of the femoral head: A systematic review and meta-analysis - 03/12/20

Doi : 10.1016/j.otsr.2020.07.004 
Wang Deng, Zhaolun Wang, Yixin Zhou , Hongyi Shao, Dejin Yang, Hua Li
 Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, 100035 Beijing, The People's Republic of China 

Corresponding author.

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Abstract

Background

Core decompression (CD) is effective in relieving pain and delaying the progression to total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH). However, the influence of CD on subsequent THA has not yet been established. Therefore, we performed this systematic review to answer: does prior CD have detrimental effect on subsequent THA for ONFH, especially with regards to survivorship and functional results, as well as perioperative and postoperative complications.

Patients and methods

After registration on PROSPERO (CRD42019118861), literature published up to and including November 2018 was searched in the PubMed, Embase and Cochrane library databases with predetermined terms. Comparative studies on the clinical outcomes between conversion to THA with prior CD (the Prior CD group) and primary THA (the Control group) for ONFH were included. The outcomes of interest included survivorship free from revision, the postoperative functional performance, perioperative and postoperative complications. Data was extracted systematically and a meta-analysis was performed.

Results

Overall, 5 retrospective cohort studies with 110 hips were identified for the Prior CD group and 237 hips were identified for inclusion in the Control group. All of the studies were of high quality in terms of the Newcastle-Ottawa Scale. No difference in the rate of revision between the two groups (2/42 (4.8%) vs. 4/160 (2.5%); RR=1.92; 95% CI=0.34 to 10.75; p=0.46) was detected after a minimum two-year follow-up. The mean postoperative Harris Hip Score was similar between the two groups in all 5 studies. The two groups experienced similar blood loss (Mean difference=12.17ml; 95% CI= -15.28 to 39.61ml; p=0.38). Moreover, intraoperative fracture was increased in the Prior CD group, though this did not reach statistical significance (3/31 (9.7%) vs. 0/55 (0.0%); RR=7.05; 95% CI=0.82 to 60.78; p=0.08). Similarly, osteolysis or radiolucent lines were more likely to occur in the Prior CD group without statistical significance (9/81 (11.1%) vs. 6/200 (3.0%); RR=3.14, 95% CI=0.98 to 10.06; p=0.05).

Discussion

The present evidence indicated that prior CD does not detrimentally affect the survivorship nor hip scores of subsequent THA. Attention should be paid, however, to the potential for intraoperative fracture, postoperative osteolysis or radiolucent lines.

Level of evidence

III; systematic review and meta-analysis of level III retrospective comparative studies.

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Keywords : Hip, Core decompression, Total hip arthroplasty, Osteonecrosis, Femoral head, Meta-analysis

Abbreviations : ONFH, THA, CD, HHS, RR, CI


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Vol 106 - N° 8

P. 1553-1560 - décembre 2020 Retour au numéro
Article précédent Article précédent
  • Periacetabular osteotomy vs. total hip arthroplasty in young active patients with dysplastic hip: Systematic review and meta-analysis
  • Chul-Ho Kim, Ji Wan Kim
| Article suivant Article suivant
  • Does augmented core decompression decrease the rate of collapse and improve survival of femoral head avascular necrosis? Case-control study comparing 184 augmented core decompressions to 79 standard core decompressions with a minimum 2 years’ follow-up
  • Pierre Martinot, Julien Dartus, Arthur Justo, Hicham Riouach, Paul Cremer, Charles-Henri Flouzat-Lachaniette, Philippe Hernigou, Luc Kerboull, Philippe Chiron, French Society of Orthopaedic Surgery and Traumatology (SoFCOT)

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