Guo Jiale, He Qionghan, Sun Yue, Liu Xianglong, Li Yehai
Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, China.
Department of Infectious Diseases, Chaohu Hospital of Anhui Medical University, Hefei, China.
Medicine (Baltimore). 2024 Dec 13;103(50):e40348. doi: 10.1097/MD.0000000000040348.
Nowadays, total hip arthroplasty (THA) is one of the most successful procedures in the field of orthopedics and trauma. The posterior approach has historically been associated with a higher rate of hip dislocation. To reduce the rate of hip dislocation in the posterior approach, most orthopedic surgeons would recommend hip precautions (HP) for their patients postoperatively based on previous theories. However, recent randomized controlled trials have shown no significant difference in hip dislocation rates with or without HP, in contrast to previous theories. Based on these, this study conducted a meta-analysis of these randomized controlled trials to try to get qualitative conclusions.
Randomized controlled trials of HP after THA up to July 28, 2023, were searched in 3 databases, PubMed, Embase, and the Cochrane Library. Data extraction and literature quality assessment were performed by 2 independent authors and extracted hip dislocation, hip disability and Osteoarthritis Outcome Score, joint replacement (HOOS JR) scores over 6 weeks, and time to discontinuation of mobility aids. Stata software and Revman software were used to perform this meta-analysis.
Following screening, 3 papers with a total of 1215 participants were included in the analysis. This meta-analysis showed that there was no statistically significant difference in hip dislocation rates with or without HP after THA undergoing the posterior approach and that the without HP group instead showed better outcomes in terms of HOOS JR scores and time to discontinuation of mobility aids.
THA with a posterior approach does not require hip precautions.
如今，全髋关节置换术（THA）是骨科和创伤领域最成功的手术之一。传统上，后入路与较高的髋关节脱位率相关。为了降低后入路的髋关节脱位率，大多数骨科医生会根据以往的理论为患者术后推荐髋关节预防措施（HP）。然而，最近的随机对照试验表明，与以往理论相反，有无HP的髋关节脱位率并无显著差异。基于此，本研究对这些随机对照试验进行了荟萃分析，试图得出定性结论。
在3个数据库（PubMed、Embase和Cochrane图书馆）中检索截至2023年7月28日的THA术后HP的随机对照试验。由2名独立作者进行数据提取和文献质量评估，并提取髋关节脱位、髋关节功能障碍和骨关节炎疗效评分、关节置换（HOOS JR）6周以上评分以及停用助行器的时间。使用Stata软件和Revman软件进行此荟萃分析。
经过筛选，3篇论文共1215名参与者被纳入分析。该荟萃分析表明，后入路THA术后有无HP的髋关节脱位率无统计学显著差异，且无HP组在HOOS JR评分和停用助行器时间方面表现更好。
后入路THA不需要髋关节预防措施。
