What is the risk of dislocation after hip arthroplasty for patients with neuromuscular disease: a systematic review and meta-analysis.

Abstract

Purpose: Recent research has demonstrated excellent functional outcomes for patients with neuromuscular (NM) disease undergoing hip arthroplasty (HA). However, significant concerns persist regarding a potentially elevated risk of postoperative instability and dislocation in this specific cohort. Therefore, our objective was to synthesize the existing evidence through a systematic review and meta-analysis to evaluate the risks of dislocation in NM patients after HA. The purpose of this study was to answer the following question using a systematic review and meta-analysis: for patients undergoing HA (P), does the presence of a NM disease (I) increase the risk of postoperative dislocation (O) compared to patients without a NM disease (C)?

Methods: A meta-analysis was conducted from inception to December 2024, utilizing multiple database searches (PubMed, Embase, Web of Science, and Cochrane Library). Two authors independently selected studies, assessed their quality, and extracted relevant data. Disagreements were resolved through discussion with a third author. A fixed-effects meta-analysis model was used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Statistical heterogeneity was assessed using the I 2 statistic.

Results: Six studies were included, involving 22,803 patients; 2,643 NM and 20,160 non-NM underwent HA. We found the risk of dislocation in the NM group is higher than that in the non-NM group (OR: 1.59; 95% CI: 1.24-2.03; I 2 = 0%); the NM group of elderly patients with combined femoral neck fractures also increases (OR: 1.63; 95% CI: 1.22-2.17; I 2 = 0%).

Conclusion: In conclusion, the findings of this systematic review and meta-analysis provide robust evidence that patients with pre-existing NM disease face a substantially elevated risk of postoperative dislocation following HA. Our meta-analysis indicates that patients with NM diseases are at a heightened risk of dislocation following HA (OR: 1.59; 95% CI: 1.24-2.03, P < 0.001). This finding underscores the need for heightened preoperative counseling, meticulous surgical technique, and potentially the use of enhanced stability constructs in this vulnerable patient group.