Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China.
FRCS (Edinburgh) Kuching Specialist Hospital Sarawak, Tabuan Stutong Commercial Centre, 93350, Kuching Sarawak, Malaysia.
J Orthop Surg Res. 2023 Aug 8;18(1):586. doi: 10.1186/s13018-023-04023-w.
The positioning of implant components for total hip arthroplasty (THA) is essential for joint stability, polyethylene liner wear, and range of motion. One potential benefit of the direct anterior approach (DAA) for THA is the ability to use intraoperative fluoroscopy for acetabular cup positioning and limb-length evaluation. Previous studies comparing intraoperative fluoroscopy with no fluoroscopy during DAA have reported conflicting results. This meta-analysis aimed to evaluate whether intraoperative fluoroscopy improves component positioning compared to no fluoroscopy during direct anterior total hip arthroplasty.
A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. We searched Web of Science, EMBASE, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database in May 2023 to identify studies involving intraoperative fluoroscopy versus no fluoroscopy during direct anterior total hip arthroplasty. Finally, we identified 1262 hips assessed in seven studies.
There were no significant differences in terms of acetabular cup inclination angle (ACIA, P = 0.21), ACIA within safe zone rate (P = 0.97), acetabular cup anteversion angle (ACAA, P = 0.26); ACAA within safe zone rate (P = 0.07), combined safe zone rate (P = 0.33), and limb-length discrepancy (LLD, P = 0.21) between two groups.
Even though intraoperative fluoroscopy was not related to an improvement in cup location or LDD. With fewer experienced surgeons, the benefit of intraoperative fluoroscopy might become more evident. More adequately powered and well-designed long-term follow-up studies were required to determine whether the application of the intraoperative fluoroscopy for direct anterior total hip arthroplasty will have clinical benefits and improve the survival of prostheses.
全髋关节置换术（THA）中植入物组件的定位对于关节稳定性、聚乙烯衬垫磨损和活动范围至关重要。THA 直接前入路（DAA）的一个潜在优势是能够在术中使用透视来定位髋臼杯和评估肢体长度。先前比较 DAA 术中透视与无透视的研究报告结果存在冲突。本荟萃分析旨在评估与 DAA 期间无透视相比，术中透视是否能改善组件定位。
我们按照系统评价和荟萃分析的首选报告项目指南进行了系统综述。我们于 2023 年 5 月在 Web of Science、EMBASE、PubMed、Cochrane 对照试验登记处、Cochrane 图书馆、Highwire、CBM、CNKI、VIP 和万方数据库中进行了检索，以确定涉及 DAA 期间术中透视与无透视比较的研究。最终，我们确定了 7 项研究中的 1262 个髋关节进行了评估。
两组间髋臼杯倾斜角（ACIA，P=0.21）、髋臼杯在安全区内的比例（P=0.97）、髋臼杯前倾角（ACAA，P=0.26）、髋臼杯在安全区内的比例（P=0.07）、联合安全区内的比例（P=0.33）和肢体长度差异（LLD，P=0.21）均无显著差异。
即使术中透视与杯位或 LLD 的改善无关。随着经验较少的外科医生的增加，术中透视的益处可能会变得更加明显。需要进行更多设计合理、长期随访的研究，以确定 DAA 中应用术中透视是否会带来临床获益并提高假体的生存率。
