A systematic review and meta-analysis of hip preservation osteotomy in osteonecrosis of femoral head

Abstract

Background: Osteonecrosis of the femoral head occurs when there is insufficient vascularization of the femoral head, leading to bone cell death and potential bone collapse. Osteotomy is a hip preservation procedure often reserved for young patients. Necrotic lesion size and site are believed to be crucial factors in predicting the outcome of the procedure. Methods: The authors performed this systematic review in line with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) 2020 statement. The review protocol had been registered on PROSPERO. A literature search was performed using electronic databases including studies published within the past 10 years. As our objective was to examine the correlation between preoperative necrotic size and osteotomy outcome, the authors focused on patients with early-stage osteonecrosis of the femoral head who underwent rotational or angular preservation osteotomy. The Newcastle–Ottawa Quality Assessment Scale was utilized to assess the included studies’ quality. Results: Of the 1217 articles initially identified, 18 met the inclusion criteria. Pooled data of 78 hips showed favorable outcomes in Kerboul Angle <200o group with an OR 0.06 (95% CI: 0.01–0.39). Meanwhile, pooled 276 hips were assessed using the JIC type yielded in an OR 0.55 (95% CI: 0.10–2.9), which showed better outcomes for hips with JIC types A, B, and C1. Conclusion: A consensus on eligibility based on necrosis quantification has not been reached when choosing an osteotomy procedure. The ability to predict osteotomy outcomes in patients diagnosed with JIC type A-C1 and a Kerboul angle <200° remains uncertain. It is important to note that prior recommendations to perform osteotomy based on these parameters may still hold relevance attributable to the low importance of the statistical data obtained.