Effects of total hip arthroplasty for primary hip osteoarthritis on postural balance: A systematic review

Abstract

Background: Hip osteoarthritis is one of the major causes of disability worldwide, and although total hip arthroplasty is considered effective in the management of this condition, its effects on postural balance remain unclear.

Research question: What are the effects of total hip arthroplasty for primary hip osteoarthritis on the postural balance compared to preoperative status and/or to healthy controls?.

Method: A systematic review was conducted, and the Embase, Latin American and Caribbean Health Sciences (LILACS), PubMed, Scopus, The Cochrane Library, and Web of Science databases were searched. Randomized and non-randomized studies were considered eligible for inclusion. The risk of bias of included studies was assessed using the Joanna Briggs Institute critical appraisal tools.

Results: Among the 41 potentially eligible studies, 13 studies were included for qualitative synthesis-8 studies had low risk of bias and 5 had moderate risk of bias. Ten studies compared the effects of total hip arthroplasty on the postural balance in healthy controls. Meanwhile, the remaining 3 studies compared such effects to the preoperative status only. Comparable results on the postural balance between the intervention and control groups were observed in 5 studies, whereas 3 studies showed better scores among healthy controls. The other 2 studies reported that postural balance could still be impaired at 6 months to 3 years postoperatively. All 3 studies with no healthy controls reported an improvement in the postural balance compared to the preoperative status.

Conclusions: Major post-surgical improvements were consistently observed compared to preoperative status, although postural balance impairment was still noted compared to healthy controls.

Significance: The results of this study might be a useful guide for clinicians on the extent of the therapeutic effects of hip arthroplasty on postural balance. Furthermore, the standardization of balance assessment tools could strengthen the certainty of cumulative evidence in future studies.

Keywords: Evidence-based medicine; Postural balance; Systematic review; Total hip arthroplasty.