Orthopedic Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
Orthopaedic and Traumatology Department, Assiut University School of Medicine, Assuit, 71515, Egypt.
BMC Musculoskelet Disord. 2024 Oct 7;25(1):792. doi: 10.1186/s12891-024-07868-2.
The aim was to investigate the effect of surgeon handedness on acetabular cup positioning, functional outcomes, and dislocation incidence during primary THA.
A systematic review was conducted according to the PRISMA guidelines. Studies published in English were searched in three databases (PubMed, Embase, and Scopus). A dominant side is a right-handed (RHD) or left-handed (LHD) surgeon who operates on the right or left hip, respectively. The opposite is considered to be the non-dominant side. We used odds ratios for dichotomous data and mean differences for continuous data, with 95% confidence intervals for quantitative data synthesis. Heterogeneity was assessed using the I² test, with outcomes graphically represented in a forest plot and a p-value of < 0.05 considered statistically significant; analyses were performed using Review Manager 5.4 (RevMan 5.4.1). >.
Four observational studies were included out of 98 articles. Ten experienced surgeons participated (8 RHD and 2 LHD) and operated on 822 patients (1484 hips), divided equally between dominant and non-dominant sides, and the posterolateral approach was utilized in 80.9% of THAs. RHD surgeons operated on 1404 (94.6%) THAs. The pooled synthesis for inclination indicated no significant difference between either side [MD: 0.10 (95% CI -2.10 to 2.30, P = 0.93, I² = 91%)]. While the difference was significant for anteversion [MD: -2.37 (95% CI -3.82 to -0.93, P = 0.001, I² = 31%)]. The functional outcome was better on the dominant side [MD: 1.44 (95% CI 0.41 to 2.48, P = 0.006, I² = 0%)], and the dislocation incidence was significantly higher on the non-dominant side [OR: 0.45 (95% CI 0.25 to 0.81, P = 0.008, I² = 0%)].
Surgeon handedness and whether operating on the dominant or non-dominant side could affect the acetabular cup positioning and outcomes during primary THAs, even in the hands of high-volume surgeons.
本研究旨在探讨术者利手对初次全髋关节置换术（THA）中髋臼杯定位、功能结果和脱位发生率的影响。
根据 PRISMA 指南进行系统评价。在三个数据库（PubMed、Embase 和 Scopus）中检索发表的英文研究。优势手是指右利手（RHD）或左利手（LHD）医生分别在右侧或左侧髋关节手术，相对的是非优势手。我们使用二项数据的优势比值和连续数据的平均差异，定量数据综合采用 95%置信区间。使用 I²检验评估异质性，结果以森林图表示，p 值<0.05 认为具有统计学意义；使用 Review Manager 5.4（RevMan 5.4.1）进行分析。>.
从 98 篇文章中纳入了 4 项观察性研究。10 名经验丰富的外科医生参与，分别为 8 名 RHD 和 2 名 LHD，对 822 名患者（1484 髋）进行了手术，优势侧和非优势侧各占一半，80.9%的 THA 采用后外侧入路。RHD 医生进行了 1404 例（94.6%）THA。髋臼杯倾斜度的综合分析结果表明，两侧之间无显著差异[MD：0.10（95% CI -2.10 至 2.30，P=0.93，I²=91%）]。然而，前倾角的差异有统计学意义[MD：-2.37（95% CI -3.82 至 -0.93，P=0.001，I²=31%）]。优势侧的功能结果更好[MD：1.44（95% CI 0.41 至 2.48，P=0.006，I²=0%）]，而非优势侧的脱位发生率显著更高[OR：0.45（95% CI 0.25 至 0.81，P=0.008，I²=0%）]。
即使在高容量外科医生手中，术者利手和手术优势侧或非优势侧可能会影响初次 THA 中的髋臼杯定位和结果。
