Total hip arthroplasty with subtrochanteric osteotomy for severe developmental dysplasia of the hip: A systematic review and meta-analysis.

BACKGROUND

Total hip arthroplasty (THA) for severe developmental dysplasia of the hip (DDH) is technically difficult because of the anatomical features of dysplasia, such as a hypoplastic and shallow acetabulum, narrow femoral canal, and soft tissue contractures. Subtrochanteric osteotomy (STO) is effective technique to reduce the risk of sciatic nerve palsy while placing the acetabular cup in an anatomical position during THA for severe DDH. Few studies have compared THA performed without STO to THA performed with STO. We performed a systematic literature review and single-arm meta-analysis to integrate the results of studies regarding THA with STO for severe DDH.

PATIENTS AND

METHODS

A systematic literature review was conducted using relevant original studies from various databases. Pooling of data was performed using RevMan software. A p-value of <0.05 was considered significant. The results are expressed as incidences with 95 % confidence intervals (CIs) for dichotomous data and means with 95 % CI for continuous data. Statistical heterogeneity was assessed based on I 2 using the standard χ2 test. When I 2 > 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

Twelve studies were included in this meta-analysis. The pooled incidence of sciatic nerve palsy, delayed union or nonunion, dislocation, intraoperative femoral fracture, and infection were 2.44 % (95 % CI: 0.86-4.01), 2.74 % (95 % CI: 1.11-4.37), 2.92 % (95 % CI: 1.63-4.20), 2.19 % (95 % CI: 0.95-3.42), and 3.11 % (95 % CI: 0.10-6.12), respectively. Pooling of the data also showed a mean Harris Hip Score (HHS) of 88.33 (95 % CI: 84.95-91.70).

DISCUSSION: Although THA with STO for severe DDH is a challenging surgical procedure, this meta-analysis showed that the results of THA with STO for severe DDH are favourable. Level of evidence: Ⅳ (systematic review and meta-analysis).