Abstract
Purpose
The objective of this study is to evaluate the outcomes of total hip arthroplasty (THA) in patients with radiation-related changes to the bone, and specifically whether there is a difference in outcomes between cemented and uncemented acetabular components.
Methods
A database search was performed to identify available studies reporting adults undergoing THA who have previously had pelvic irradiation. Data were extracted and analysed with respect to the use of cemented versus uncemented acetabular components. Statistical analysis was performed using the Chi-square test for independence.
Results
The all-cause revision rate was 24% in the cemented THA group (27/111), compared with 15% of uncemented THAs (22/143) (p = 0.073). Revision for acetabular aseptic loosening occurred in 16% of cases (18/111) in the cemented group and 10% (15/143) in the uncemented group (p = 0.178). Acetabular aseptic loosening was reported in 24% of cemented THAs (27/111) and 14% of uncemented THAs (20/143), which was statistically significant (p = 0.035). Not all of these went on to have revision THA. The Incidence of prosthetic joint infection was similar in both groups.
Conclusion
Overall outcomes appear to be better for uncemented THAs in post-radiotherapy patients, with a significantly lower rate of aseptic loosening and an appreciable (but not statistically significant) reduction in revision rate. The best outcomes seem to be associated with the use of acetabular reinforcement across both cemented and uncemented groups, but further work is needed to evaluate this.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Smithers D (1946) Radiotherapy and cancer. Postgrad Med J 22:127–144
NHS, “Radiotherapy,” (2017). https://www.nhs.uk/conditions/radiotherapy/. Accessed 27 May 2018
Dalinka MK, Edeiken J, Finkelstein JB (1974) Complications of radiation therapy: adult bone. Semin Roentgenol 9(1):29–40
Howland WJ, Loeffler RK, Starchman DE, Johnson RG (1975) Postirradiation atrophic changes of bone and related complications. Radiology 117(3 Pt 1):677–685
Mitchell MJ, Logan PM (1998) Radiation-induced changes in bone. Radiographics 18(5):1125–1136 (quiz 1242-3)
Duparc J, Bocquet C, Frot B, Gastambide D (1977) Radiation lesions of the hip. Rev Rhum Mal Osteoartic 44(2):79–89
Grigsby PW, Roberts HL, Perez CA (1995) Femoral neck fracture following groin irradiation. Int J Radiat Oncol Biol Phys 32(1):63–67
Duparc J, Massin P (1996) Surgical treatment of radiation-induced lesions of the hip in adults. Bull Acad Natl Med 180(8):1815–1836 (discussion 1836-9)
Kwon JW, Huh SJ, Yoon YC, Choi SH, Jung JY, Oh D, Choe BK (2008) Pelvic bone complications after radiation therapy of uterine cervical cancer: evaluation with MRI. AJR Am J Roentgenol 191(4):987–994
Massin P, Duparc J (1995) Total hip replacement in irradiated hips. A retrospective study of 71 cases. J Bone Joint Surg Br 77(6):847–852
Cho MR, Kwun KW, Lee DH, Kim SY, Kim JD (2005) Latent period best predicts acetabular cup failure after total hip arthroplasties in radiated hips. Clin Orthop Relat Res 438:165–170
Felden A, Vaz G, Kreps S, Anract P, Hamadouche M, Biau DJ (2015) A cemented acetabular component with a reinforcement cross provides excellent medium-term fixation in total hip arthroplasty after pelvic irradiation. Bone Joint J 97-B(2):177–184
Jacobs JJ, Kull LR, Frey GA, Gitelis S, Sheinkop MB, Kramer TS, Rosenberg AG (1995) Early failure of acetabular components inserted without cement after previous pelvic irradiation. J Bone Joint Surg Am 77(12):1829–1835
Kim KI, Klein GR, Sleeper J, Dicker AP, Rothman RH, Parvizi J (2007) Uncemented total hip arthroplasty in patients with a history of pelvic irradiation for prostate cancer. J Bone Joint Surg Am 89(4):798–805
Joglekar SB, Rose PS, Lewallen DG, Sim FH (2012) Tantalum acetabular cups provide secure fixation in THA after pelvic irradiation at minimum 5-year followup. Clin Orthop Relat Res 470(11):3041–3047
De Paolis M, Zucchini R, Romagnoli C, Romantini M, Mariotti F, Donati D (2015) Short term results of tantalum acetabular cups in total hip arthroplasty following pelvic irradiation. In: International Society of Limb Salvage (ISOLS) & Musculoskeletal Tumour Society (MSTS) 2015 annual meeting, Orlando, Florida
Kang HS, Kim T, Chung SK (2018) Resection arthroplasty in radiation-induced osteonecrosis of the hip. J Clin Orthopa Trauma. https://doi.org/10.1016/j.jcot.2018.02.016
Demircay E, Unay K, Sener N (2009) Cementless bilateral total hip arthroplasty in a patient with a history of pelvic irradiation for sarcoma botryoides. Med Princ Pract 18(5):411–413
Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed1000097
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Walters, S., Prasad, A., Guevel, B. et al. Systematic review of the outcome of cemented versus uncemented total hip arthroplasty following pelvic irradiation. Musculoskelet Surg 103, 221–230 (2019). https://doi.org/10.1007/s12306-019-00597-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12306-019-00597-z