Abstract
BackgroundVarious Joint-preserving therapy (JPT) methods have been performed and tried in recent decades, but their results and efficacy were inconsistent and controversial. The purpose of this study is to evaluate its effectiveness and whether there are statistical differences in treatment between different interventions based on published RCT studies.MethodsFollowing the PRISMA-NMA checklist, Medline, EMBASE, Web of Science, and Cochrane Library databases were searched and collected related RCT studies. The sources were searched from inception up to October 30, 2020. The primary outcomes including the rate of radiographic progression and conversion to THA and the secondary outcome -Harris Hip Scores (HHS) were extracted and compared in a Network meta-analysis.ResultsSeventeen RCT studies involving 784 patients (918 hips) with seven interventions including CD (core decompression), CD + BG (bone graft), CD + TI (tantalum rod implantation), CD + CT (Cell therapy), CD + BG + CT, VBG (vascularized bone graft), and nonsurgical or conservative treatment for ONFH were evaluated. In the radiographic progression results, CD + CT showed a relatively better result than CD, CD + BG and non-surgical treatment, the surface under the cumulative ranking curve (SUCRA) plot displayed that CD + CT (96.4%) was the best, followed by CD (64.1%).In conversion to THA results, there were no significant differences between the JPT methods and non-surgical treatment. In HHS, there was also no significant difference, other than CD + BG showed a statistical difference than non-surgical treatment only in terms of Cis, but the SUCRA was highest in non-surgical treatment (80.5%) followed by CD + CT (72.8%).ConclusionsThis Net-work meta-analysis demonstrated that there was no statistical difference in the outcome of radiographic progression and conversion to THA, also in HHS, other than CD + CT showed a relatively superior result in radiographic progression than nonsurgical treatment, namely, it’s maybe an effective method for delaying disease progression or reducing disease development based on current evidence.
Highlights
Various Joint-preserving therapy (JPT) methods have been performed and tried in recent decades, but their results and efficacy were inconsistent and controversial
In the radiographic progression results, core decompression (CD) + CT showed a relatively better result than CD, CD + bone graft (BG) and non-surgical treatment, the surface under the cumulative ranking curve (SUCRA) plot displayed that CD + CT (96.4%) was the best, followed by CD
In Harris Hip Scores (HHS), there was no significant difference, other than CD + BG showed a statistical difference than non-surgical treatment only in terms of confidence intervals (Cis), but the SUCRA was highest in non-surgical treatment (80.5%) followed by CD + CT (72.8%)
Summary
Various Joint-preserving therapy (JPT) methods have been performed and tried in recent decades, but their results and efficacy were inconsistent and controversial. If there is no timely and effective treatment in the early stage, 80% of cases will have femoral head collapse and end-stage degenerative joint disease within 2 years, and eventually need to total hip arthroplasty (THA) [3,4,5]. The principles for considering ONFH treatment include the termination of pathologic progression and the restoring of weight-bearing capacity, many different jointpreserving therapy (JPT) methods have been performed in recent decades-years. Based on published data in the USA by Sodhi, N [13], there was an increasing rate of THA for ONFH (75 to 88%) [14] during 1992 to
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