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Complications and Functional Outcomes of Total Hip Arthroplasty After Pelvic Radiation: A Systematic Review and
José M Lamo-Espinosa1, Gonzalo Mariscal2, Jorge Gómez-Álvarez3
1Department of Orthopedic Surgery, IMED Colón, Valencia, Spain; Institute for Research on Musculoskeletal Disorders, Valencia Catholic University, Valencia, Spain.
Background:
Total hip arthroplasty (THA) outcomes in patients who have prior pelvic irradiation require careful evaluation due to the growing cancer survivor population and increased radiotherapy use. Radiation's adverse effects on bone may compromise prosthesis integration.
Methods:
A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted across multiple databases examining THA complications in postpelvic radiation patients. The analysis included cohort studies and clinical series evaluated using Methodological Index for Nonrandomized Studies criteria. Data pooling utilized the generic inverse variance method, with sensitivity analyses for radiation dose, percentage of patients who had osteoradionecrosis, and radiation-to-THA timing.
Results:
Analysis of 12 studies (2,876 patients) with follow-up ranging from 24 to 120 months revealed: dislocation rate of 8.2% (4.3 to 12.0); aseptic loosening in 15.0% (0 to 34.3); septic loosening in 6.6% (4.1 to 9.1); radiolucency in 23.1% (9.6 to 36.6); revision surgeries in 13.9% (2.6 to 25.2), and intraoperative complications in 5.6% (0.3 to 10.9). Radiation dose did not influence outcomes, while longer radiation-to-THA intervals reduced complications. Harris Hip Score improved significantly (mean 37.4, 95% confidence interval 27.0 to 47.7). Studies with a higher percentage of patients who had osteoradionecrosis presented a higher rate of complications.
Conclusions:
Total hip arthroplasty following pelvic radiation carries high complication risks, especially in patients who have osteoradionecrosis. Functional outcomes showed significant improvement at the final follow-up.
