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Review
. 2022 Aug 30:2022:7256664.
doi: 10.1155/2022/7256664. eCollection 2022.

Meta-analysis of the Efficacy of the Anatomical Center and High Hip Center Techniques in the Treatment of Adult Developmental Dysplasia of the Hip

Chen Wu  1 , Guoyin Shu  1 , Xiaowei Xie  1 , Xin Yuan  1 , Shirong Chen  1
Affiliations
Review

Meta-analysis of the Efficacy of the Anatomical Center and High Hip Center Techniques in the Treatment of Adult Developmental Dysplasia of the Hip

Chen Wu et al. Biomed Res Int. .

Abstract

Background: In total hip arthroplasty for the treatment of adult developmental dysplasia of the hip, there is considerable controversy regarding the placement of the acetabular cup, anatomic center, and upward in acetabular reconstruction. This article explores the efficacy of the anatomical center technique and high hip center technique in the treatment of adult developmental dysplasia of the hip.

Method: By searching for articles in the Cochrane Library, PubMed, CNKI, and Wanfang databases, we collected the literature on the treatment of adult developmental dysplasia of the hip by anatomical center and high hip center technology and screened the literature according to the inclusion and exclusion criteria. The Cochrane risk of bias assessment tool was used to assess the risk of bias of randomized controlled trials, the quality of the literature in retrospective cohort studies was assessed using the Newcastle-Ottawa scale, and the RevMan 5.4 software was used to analyze the extracted outcome indicators.

Results: Nine studies were finally included, including one prospective cohort study, eight retrospective cohort studies, two high-quality studies, and six moderate-quality studies. The meta-analysis results showed that the reconstruction of the acetabulum in two positions was significantly different in terms of operation time (WMD = -37, 95% CI: -45.25-28.74, P < 0.00001), intraoperative blood loss (WMD = -91.88, 95% CI: -108.57-75.19, P < 0.00001), postoperative drainage volume (WMD = 80.55, 95% CI: -140.56-301.66, P = 0.48), time to ground (WMD = -0.68, 95% CI: -1.37-0.0, P = 0.05), Harris score (WMD = -0.04, 95% CI: -0.91-0.82, P = 0.92), lower limb length difference (WMD = 0.21, 95% CI: -0.22-0.64, P = 0.33), WOMAC score (WMD = -1.24, 95% CI: -4.89-2.41, P = 0.51), postoperative complications (RD = -0.02, 95% CI: -0.06-0.02, P = 0.44), Trendelenburg sign (RD = -0.02, 95% CI: -0.02-0.05,P = 0.31), limb lengthening (WMD = 0.85, 95% CI: 0.61-1.09, P < 0.00001), prosthesis wear (WMD = 0.01, 95% CI: 0-0.02, P = 0.17), and prosthesis loosening (RD = 0.01, 95% CI: -0.02-0.04, P = 0.45).

Conclusions: The high hip center technique can reduce operative time, intraoperative blood loss, and downtime. The anatomical center technique is superior to the high hip center technique in terms of limb lengthening. Compared with acetabular anatomical reconstruction, there was no significant difference in postoperative drainage, lower limb length difference, postoperative complications, Trendelenburg sign, and prosthesis survival or wear. For DDH patients who are not severely shortened in the lower limbs and have severe acetabular bone defects, joint surgeons can choose to reconstruct the acetabulum in the upper part to simplify the operation, reduce the trauma of the patient, and accelerate the recovery of the patient, and they can choose to adjust the length of the neck and the angle of the neck shaft to maintain the moment arm of the abductor muscle. A ceramic interface or a highly cross-linked polyethylene interface minimizes the effect of hip response forces. To further evaluate the efficacy of the anatomical center technique and the high hip center technique in the treatment of adult developmental dysplasia of the hip, more large-sample, high-quality, long-term follow-up randomized controlled trials are still needed for verification.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Article screening process.
Figure 2
Figure 2
Risk of bias in randomized controlled trials.
Figure 3
Figure 3
Summary of bias in randomized controlled trials.
Figure 4
Figure 4
Meta-analysis forest plot for comparison of operation time between two groups.
Figure 5
Figure 5
Meta-analysis forest plot for the comparison of intraoperative blood loss between the two groups.
Figure 6
Figure 6
Meta-analysis forest plot for comparison of postoperative drainage between the two groups.
Figure 7
Figure 7
Meta-analysis forest plot for the comparison of the two groups of the time of going to the ground.
Figure 8
Figure 8
Meta-analysis forest plot for comparison of postoperative Harris scores between the two groups.
Figure 9
Figure 9
Meta-analysis forest plot for comparison of limb length difference between the two groups.
Figure 10
Figure 10
Meta-analysis forest plot for comparison of postoperative WOMAC scores between the two groups.
Figure 11
Figure 11
Meta-analysis forest plot for comparison of postoperative complications between the two groups.
Figure 12
Figure 12
Meta-analysis forest plot for the comparison of the postoperative Trendelenburg sign between the two groups.
Figure 13
Figure 13
Meta-analysis forest plot for comparison of the length of limb lengthening between the two groups.
Figure 14
Figure 14
Meta-analysis forest plot for the comparison of prosthesis wear between the two groups.
Figure 15
Figure 15
Meta-analysis forest plot for the comparison of prosthesis loosening between the two groups.
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