Hip resurfacing arthroplasty reduces dislocation and infection rates without differences in clinical outcomes compared to short and standard stems: A Network Meta-Analysis.

Abstract

Background: Total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) are established treatments for hip osteoarthritis. Recent advancements have introduced short-stem THA, which offers potential advantages in terms of bone preservation and biomechanical restauration. None of previous studies compared these three surgical interventions. The aim of this network meta-analysis (NMA) is to compare HRA, short stem and standard stem in THA in terms of: (1) complications rate (global, infection and dislocation rate), (2) clinical outcomes (WOMAC, Harris Hip Score (HHS), Oxford Hip Score (OHS), Forgotten Joint Score (FJS), Postel Merle Aubigné Score (PMA) and SF-36) at short- and mid-term, (3) procedure-related variables (operative time, pain at day one and length of stay).

Methods: A systematic literature review was conducted using multiple electronic databases (Medline, Central and Embase) to identify comparative studies evaluating at least two of the three surgical interventions. Studies were included if they reported one of our outcomes. Data synthesis was performed using a Bayesian NMA. A total of 72 studies including, 793 593 patients (mean age 54.7 years), met the inclusion criteria. The most common comparison was standard-stem THA/ HRA (94,4% of the studies).

Results: The NMA did not identify differences for the rate of global complications between short stem THA/standard-stem THA (risk ratio (RR) 1.52 [95% CI 0.41-5.96]), HRA/standard-stem THA (RR 1.17 [95% CI 0.85-1.66]) and HRA/short-stem THA (RR 0.77 [95% CI 0.20-2.95]). Regarding infection and dislocation, standard THA had a higher rate of infection (risk ratio 2.14 [95% CI 1.33-5.44]) and of dislocation (risk ratio 13.45 [95% CI 3.37-98.21]) compared to HRA. For functional outcomes at short term, no differences were observed between HRA and standard-stem THA for WOMAC (Mean Difference (MD) -0.01 [95% CI -0.51 to 0.40]), HHS (MD 0.05 [95% CI -3.26 to 3.45]), PMA (MD -0.13 [95% CI -0.94 to 0.71]) and FJS (MD -1.64 [95% CI -9.04-5.45]). For functional outcomes at mid-term, no differences were observed between HRA and standard-stem THA for WOMAC (MD -0.07 [95% CI -1.13 to 1.05]), HHS (MD -0.02 [95% CI -1.55 to 1.36]), PMA (MD -0.03 [95% CI -0.60 to 0.49]) and SF-36 (MD 0.11 [95% CI -3.37 to 3.61]). No difference was observed for comparison of short-stem THA/standard-stem THA and HRA/short-stem THA for clinical outcomes.The surgical time was shorter for HRA compared to short-stem THA (MD-34.05 [95% CI -53.25 to -13.28]) and standard-stem THA (MD -16.25 [95% CI -24.84 to -7.53]). No difference was observed between HRA and standard-stem THA for VAS at day one (MD 0.22 [95% CI -1.90 to 2.13]) and for the length of stay (MD 0.48 [95% CI -0.27 to 1.34]).

Conclusion: HRA demonstrated had lower infection and dislocation rate compared to standard THA. HRA also offers a shorter operative time. However, no difference was observed for functional outcome between the three technics. These findings support the notion that the choice of technique should be tailored to patient-specific characteristics, highlighting the potential shift towards personalized hip arthroplasty.

Level of evidence: III; Network meta-analysis.