Abstract
Background
Core decompression (CD) is effective to relieve pain and delay the advent of total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH). However, the influence of CD on the subsequent THA has not been determined yet.
Methods
Literatures published up to and including November 2018 were searched in PubMed, Embase and the Cochrane library databases with predetermined terms. Comparative studies of the clinical outcomes between conversion to THA with prior CD (the Prior CD group) and primary THA (the Control group) for ONFH were included. Data was extracted systematically and a meta- analysis was performed.
Results
Overall, five retrospective cohort studies with 110 hips in the Prior CD group and 237 hips in the Control group were included and all the studies were of high quality in terms of Newcastle-Ottawa Scale. No difference in the rate of revision between the two groups showed (RR=1.92, P=0.46) after a minimal two-year follow-up. Postoperative Harris Hip Score were similar between the two groups in all the five studies. Two groups went through similar blood loss (P=0.38). But the operative time in the Prior CD group with tantalum rob was longer than that in the Control group (P=0.006, P<0,001, respectively in two papers). Moreover, intraoperative fracture and osteolysis or radiolucent lines were more likely to occur in the Prior CD group, though there is not statistical difference (RR=7.05, P=0.08; RR=3.14, P=0.05, respectively).
Conclusion
The present evidence indicated that prior CD has no inferior effect on the survivorship nor hip scores to the subsequent THA. The operative time in the Prior CD group with tantalum rob was longer than that in the Control group. Attention should also be paid on possible more intraoperative fracture and postoperative osteolysis or radiolucent lines.
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