Lecoultre Yannic, Danek Jan, Rompen Ingmar F, van de Wall Bryan J M, Haefeli Pascal C, Beeres Frank J P, Babst Reto, Link Björn C
Luzerner Kantonsspital, Lucerne, 6000, Switzerland.
Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, 6000, Switzerland.
Arthroplasty. 2023 Apr 7;5(1):20. doi: 10.1186/s42836-023-00173-8.
Intraoperative fluoroscopy (IFC) is gaining popularity in total hip arthroplasty (THA), with the aim to achieve better component positioning and therefore eventually reduced revision rates. This meta-analysis investigated the benefit of IFC by comparing it to intraoperative assessment alone. The primary outcome was component positioning and the secondary outcomes included complications and revision rates.
PubMed, Embase and Cochrane Central Register of Controlled Trials were searched for both randomized clinical trials (RCT) and observational studies. Effect estimates for radiographic cup position, offset/leg length difference and outliers from a safe zone were pooled across studies using random effects models and presented as a weighted odds ratio (OR) with a corresponding 95% confidence interval (95% CI).
A total of 10 observational studies involving 1,394 patients were included. No randomized trials were found. IFC showed no significant reduction in acetabular cup position (inclination and anteversion), offset, leg-length discrepancies, revision (none reported) or overall complication rates.
The current meta-analysis found no differences in cup positioning, offset, leg length discrepancy, the incidence of complications or revision surgery. It should be acknowledged that the included studies were generally performed by experienced surgeons. The benefit of intraoperative fluoroscopy might become more evident at an early phase of the learning curve for this procedure. Therefore, its role has yet to be defined.
术中透视（IFC）在全髋关节置换术（THA）中的应用越来越广泛，目的是实现更好的假体组件定位，从而最终降低翻修率。本荟萃分析通过将术中透视与单纯术中评估进行比较，研究了术中透视的益处。主要结局是假体组件定位，次要结局包括并发症和翻修率。
检索了PubMed、Embase和Cochrane对照试验中央注册库，以查找随机临床试验（RCT）和观察性研究。使用随机效应模型汇总各研究中关于髋臼杯位置、偏心距/腿长差异和安全区外异常值的效应估计值，并以加权比值比（OR）及相应的95%置信区间（95%CI）表示。
共纳入10项涉及1394例患者的观察性研究。未找到随机试验。术中透视在髋臼杯位置（倾斜度和前倾角）、偏心距、腿长差异、翻修（均未报告）或总体并发症发生率方面未显示出显著降低。
当前的荟萃分析发现，在髋臼杯定位、偏心距、腿长差异、并发症发生率或翻修手术方面没有差异。应该认识到，纳入的研究通常是由经验丰富的外科医生进行的。术中透视的益处可能在该手术学习曲线的早期阶段更为明显。因此，其作用尚未明确。
