Total Hip Arthroplasty After Failed Less Invasive Hip Preservation Surgery for Osteonecrosis of the Femoral Head: A Systematic Review and Meta-analysis

BackgroundLess invasive hip-preserving surgery (LIHP) is an effective treatment in delaying total hip arthroplasty (THA) for young patients with osteonecrosis of the femoral head (ONFH). But the success rate of it was not as effective as expected and were significantly reduced with the advancement of the diseases stages. Therefore, it is essential to analysis the impact of LIHP on subsequent THA.MethodsThe search language was restricted to Chinese and English, and the references of included studies were also searched. Chinese databases including CNKI, Wan-Fang databases and VIP, and English databases including PubMed, Embase and Cochrane library were searched by the computer from the inception of each database to 23rd May 2021. The outcome indicators were extracted from the included literature and analyzed by Cochrane Collaboration Review Manager software (RevMan version 5.4). The quality of the studies was scored using the Newcastle-Ottawa scale (NOS).ResultsA total of nine articles met the inclusion and were included in this meta-analysis, two of them were published in Chinese and the remaining studies were published in English. Results showed that the LIHP group has longer operative time (SMD=17.31, 95%CI=6.29 to 28.32, p=0.002), more intraoperative blood loss (SMD=79.90, 95%CI=13.92 to 145.87, p=0.02) and higher rate of varus or valgus femoral stem (OR=4.17, 95%CI=1.18 to 14.71, p=0.03) compared to primary THA group. The risk of intraoperative fracture was higher in the prior LIHP THA group compared with primary THA group but the difference was not statistically significant (OR=5.88, 95%CI=0.93 to 37.05, p=0.06). While there was no significant difference in cup anteversion angle (SMD=-0.10, 95%CI=-0.61 to 0.41, p=0.70), cup inclination angle (SMD=0.58, 95%CI=-0.05 to 1.22, p=0.07), postoperative Harris Hip Score (HHS) (SMD=-0.01, 95%CI=-0.43 to 0.46, p=0.96) and survivorship (OR=1.38, 95%CI=0.34 to 5.55, p=0.65) between THA groups with and without prior LIHP.ConclusionAlthough the prior LIHP increased the difficulty of the conversion to THA with longer operative time, more intraoperative blood loss, and higher rate of intraoperative fracture, it does not detrimentally affect the clinical results of subsequent THA in the mid-term following-up.