Total hip arthroplasty after failed transtrochanteric rotational osteotomy for osteonecrosis of the femoral head: A systematic review and meta-analysis

Abstract Background Several studies have reported regarding total hip arthroplasty (THA) for osteonecrosis of the femoral head after failed transtrochanteric rotational osteotomy (TRO). However, to our knowledge, no formal systematic review and meta-analysis have been published yet summarizing the clinical results of a THA after failed TRO. Therefore, we conducted a systematic review and meta-analysis of the THA outcomes after failed TRO. We focussed on the issue whether a previous TRO affects the results of subsequent THA, including operative time, operative blood loss, radiological parameters, postoperative complications, and clinical outcomes. Methods Literatures published up to January 2018 were searched in the PubMed, Web of Science, and Cochrane Library, and the pooling of data was performed using a RevMan software (version 5.3, Cochrane Collaboration, Oxford, UK). A p -value  I 2 using the standard Chi 2 . 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 Five studies were included in this meta-analysis. The results showed that operative time was significantly longer in the THA after the TRO than that for the THA without previous osteotomy ( I 2  = 92%; MD = 31.62; 95% CI: 5.95 to 57.28; p  = 0.02). Operative blood loss was significantly greater in the THA after the TRO than that in the THA without previous osteotomy ( I 2  = 71%; MD = 123.30; 95% CI: 22.21 to 224.39; p  = 0.02). The rate of stem malalignment was significantly higher in the THA after the TRO than that in the THA without previous osteotomy ( I 2  = 0%; OR = 5.23, 95% CI: 1.95 to 14.06; p  = 0.001). There was no significant difference in the dislocation rate ( I 2  = 0%; OR = 2.12; 95% CI: 0.64 to 6.99; p  = 0.22), and the postoperative Harris hip score at the final follow-up ( I 2  = 75%, MD = −0.46, 95% CI: −3.92 to 3.01, p  = 0.80) between the groups. Conclusion The results demonstrate that, performing the THA after the TRO is technically more demanding than the THA without previous osteotomy. TRO does not affect the clinical results of future THA, and is a sufficient therapeutic alternative in younger patients. Level of evidence III, systematic and meta-analysis of case control studies.