A Meta-Analysis of Outcomes in Total Hip Arthroplasty Recipients Following Pelvic Irradiation

Background: Alongside advances in total hip arthroplasty (THA), innovations in the treatment of cancer have led to an increasing number of patients living with this devastating disease. Radiation therapy has well-documented clinical effects on bone health, leading to pelvic insufficiency fractures and osteonecrosis of the femoral head. The purpose of this meta-analysis is to report on THA outcomes in this patient population in an effort to determine if a need to change management exists during surgical planning. Methods: Following the Preferred Reporting Items for Systematic Review and Meta-Analysis protocols, a systematic review of published literature through August 5th, 2018 was conducted. This resulted in 8 studies in which the primary outcome measures evaluated were rates of aseptic loosening and revision THA. Results: Among 232 hips at a weighted mean follow-up time of 52 months, the aseptic loosening rate was 10% and revision THA rate was 12%. Sub-analysis of 116 THAs with cementless cups demonstrated an aseptic loosening and revision THA rate of 8% and 10%, respectively. Conclusion: The findings of the present study indicate that THA recipients who have received radiation therapy to the pelvis before arthroplasty surgery have higher rates of aseptic loosening and revision THA when compared with previously published rates in healthy THA recipients. Additionally, it is possible that female THA recipients who have received pelvic irradiation may be at a higher risk for aseptic loosening and revision THA. Surgeons should counsel patients with a history of pelvic irradiation about their potentially higher risk for these complications. (c) 2019 Elsevier Inc. All rights reserved.