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Archives of Orthopaedic and Trauma... Oct 2023Several studies have reported good to excellent outcomes of revision total hip arthroplasty (rTHA) using allografts for treating severe acetabular bone defects. However,... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Several studies have reported good to excellent outcomes of revision total hip arthroplasty (rTHA) using allografts for treating severe acetabular bone defects. However, precise information on the impact of allograft type and reconstruction method is not available.
MATERIAL AND METHODS
Systematic literature search was performed in Medline and Web of Science including patients with acetabular bone loss classified according to the Paprosky classification who underwent rTHA involving the use of allografts. Studies with a minimum follow-up of 2 years published between 1990 and 2021 were included. Kendall correlation was applied to determine the relationship between Paprosky grade and allograft type use. Proportion meta-analyses with 95% confidence interval (CI) were performed to summarize the success of various reconstruction options, including allograft type, fixation method, and reconstruction system.
RESULTS
Twenty-seven studies met the inclusion criteria encompassing 1561 cases from 1491 patients with an average age of 64 years (range 22-95). The average follow-up period was 7.9 years (range 2-22). Structural bulk and morselized grafts were used in equal proportions for all Paprosky acetabular defect types. Their use increased significantly with the type of acetabular defect (r = 0.69, p = 0.049). The overall success rate ranged from 61.3 to 98.3% with a random effect pooled estimate of 90% [95% CI 87-93]. Trabecular metal augments (93% [76-98]) and shells (97% [84-99]) provided the highest success rates. However, no significant differences between reconstruction systems, allograft types and fixation methods were observed (p > 0.05 for all comparisons).
CONCLUSION
Our findings highlight the use of bulk or morselized allograft for massive bone loss independent of Paprosky classification type and indicate similar good mid- to long-term outcomes of the different acetabular reconstruction options using allografts.
CLINICAL TRIAL REGISTRATION
PROSPERO: CRD42020223093.
Topics: Humans; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Hip Prosthesis; Follow-Up Studies; Allografts; Retrospective Studies; Acetabulum; Reoperation; Bone Transplantation; Prosthesis Failure
PubMed: 36971802
DOI: 10.1007/s00402-023-04843-9 -
European Journal of Orthopaedic Surgery... Oct 2023Post-traumatic osteoarthritis (PTOA) is a disabling complication of open reduction and internal fixation (ORIF) for acetabular fractures. There is a trend towards acute... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Post-traumatic osteoarthritis (PTOA) is a disabling complication of open reduction and internal fixation (ORIF) for acetabular fractures. There is a trend towards acute total hip arthroplasty (THA), 'fix-and-replace', in patients considered to have a poor prognosis and likelihood of PTOA. Controversy remains between early fix-and-replace, versus delayed THA as required after initial ORIF. This systematic review included studies comparing functional and clinical outcomes between acute versus delayed THA after displaced acetabular fractures.
METHODS
Comprehensive searches following the PRISMA guideline were performed on six databases for articles in English published anytime up to 29 March 2021. Two authors screened articles and discrepancies were resolved by consensus. Patient demographics, fracture classification, functional and clinical outcomes were compiled and analysed.
RESULTS
The search yielded 2770 unique studies, of which five retrospective studies were identified with a total of 255 patients. Of them, 138 (54.1%) were treated with acute and 117 (45.9%) treated with delayed THA. Delayed THA group represented a younger cohort compared to the acute group (mean age, 64.3 vs 73.3). The mean follow-up time for the acute and delayed group was 23 and 50 months, respectively. There was no difference in functional outcomes between the two study groups. Complication and mortality rates were comparable. Delayed THA had a higher revision rate compared to the acute group (17.1 vs 4.3%; p = 0.002).
CONCLUSION
Fix-and-replace had functional outcomes and complication rates similar to ORIF and delayed THA, but lower revision rates. Although the quality of studies was mixed, sufficient equipoise now exists to justify randomised studies in this area. PROSPERO registration: CRD42021235730.
Topics: Humans; Middle Aged; Arthroplasty, Replacement, Hip; Retrospective Studies; Acetabulum; Fractures, Bone; Hip Fractures; Open Fracture Reduction; Fracture Fixation, Internal; Spinal Fractures; Osteoarthritis; Treatment Outcome
PubMed: 36810707
DOI: 10.1007/s00590-023-03489-y