Total HIP arthroplasty following pelvic irradiation: a systematic review focusing on the last two decades.
Systematic Review
Radiation therapy (RT) is a standard treatment for primitive and metastatic cancers. However, it may cause adverse effects on organs and bones surrounding the target volumes. Therefore, patients with prior pelvic RT pose challenges for total hip arthroplasty (THA). This study aims to summarize the evidence on THA outcomes in this population, focusing on patient-reported measures (PROMs), revision rates, and complications./r/nA systematic literature review was conducted in October 2024 by two authors following the PRISMA guidelines on PubMed, Scopus, and Cochrane databases. RT indication, radiation dose, interval between RT and THA, specific surgical indications, implant types, postoperative PROMs, and perioperative complications were extracted and analyzed. The risk of bias was assessed through the Methodological Index for Non-Randomized Studies (MINORS) score./r/nNine articles were included, comprising 2788 patients with a mean age of 65.5 years (ranging from 19 to 90 years) who underwent pelvic irradiation for various malignancies. The average radiation dose was 5755 cGy over a 60-month follow-up period. Avascular osteonecrosis of the femoral head was the primary indication for THA. The median time between RT and THA was 6 years. The overall complication rate was 5.9% and occurred on average 60 months after surgery. Aseptic loosening and septic complications were the most common causes of failure. Across the study reporting the Harris Hip Score, the pooled mean values improved from 44.2 preoperative to 83.7 postoperatively./r/nPerforming THA in patients with previous pelvic RT carries an increased risk of complications and early failure due to compromised bone quality, reduced osseointegration capacity, and weakened immune response. Therefore, technology advancements, including tantalum or porous titanium implants and targeted antibiotic prophylaxis, may benefit this high-risk population.
