Total hip arthroplasty after pelvic osteotomy: a meta-analysis

Several studies suggested that total hip arthroplasty (THA) was more technical demanding following previous pelvic osteotomy (PO), resulting in poor outcomes compared with primary THA. However, the other studies regarding this topic had reported contradictory results. Therefore, we conducted this meta-analysis to compare the clinical results and other parameters between total hip arthroplasty following pelvic osteotomy and primary total hip arthroplasty. We systematically searched PubMed, the Cochrane Library, EMBASE, Web of Science, Scopus, EBSCO and Web of science from inception to September 2020. This study compared the outcomes between THA following previous PO and primary THA with respect to operative time, blood loss, Harris hip score (HHS), revision rates, complication rates, cup position, cup size, cup coverage and hip joint center. 14 studies with 3913 participants were included. The THA after PO group had longer operative time (MD, 13.8 mins; 95% CI, 4.73 to 22.87 mins; P=0.003), greater blood loss (MD, 82.21 ml; 95% CI, 27.94 to 136.48 ml; P=0.003), worse HHS (MD, -2.79 points; 95% CI, -4.08 to -1.50 points; P<0.00001), smaller acetabular anteversion angle (MD, -3.98°; 95% CI, -6.72 to -1.24°; P=0.004), larger cup size (MD, 1.52 mm; 95% CI, 0.75 to 2.28 mm; P=0.0001), more lateral (MD, 2.83 mm; 95% CI, 1.22 to 4.43 mm; P=0.0005) and superior (MD, 2.26 mm; 95% CI, 1.11 to 3.40 mm; P=0.0001) hip joint center. No statistically significant differences were demonstrated between the THA after PO group and primary THA group in revision rates, complication rates, acetabular abduction angle, cup coverage. THA after pelvic osteotomy was associated with inferior intraoperative outcomes, lower functional scores and worse inferior positioning of acetabular component compared with primary THA. Due to the alerted anatomical structure after PO, the findings of current study implicated that preoperative assessment such as computed tomography scan should be conducted in order to achieve satisfactory results.