Cargando…

Direct anterior approach versus posterolateral approach in total hip arthroplasty: a meta-analysis of results on early post-operative period

BACKGROUND: This study was performed to compare the advantage and disadvantage of posterolateral approach (PLA) and direct anterior approach (DAA) in total hip arthroplasty (THA). METHODS: Relevant trials were identified via a search of the Cochrane Central Register of Controlled Trials and PubMed f...

Descripción completa

Detalles Bibliográficos
Autores principales: Sun, Xuedong, Zhao, Xueli, Zhou, Licheng, Su, Zheng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816494/
https://www.ncbi.nlm.nih.gov/pubmed/33468181
http://dx.doi.org/10.1186/s13018-021-02218-7
_version_ 1783638453395652608
author Sun, Xuedong
Zhao, Xueli
Zhou, Licheng
Su, Zheng
author_facet Sun, Xuedong
Zhao, Xueli
Zhou, Licheng
Su, Zheng
author_sort Sun, Xuedong
collection PubMed
description BACKGROUND: This study was performed to compare the advantage and disadvantage of posterolateral approach (PLA) and direct anterior approach (DAA) in total hip arthroplasty (THA). METHODS: Relevant trials were identified via a search of the Cochrane Central Register of Controlled Trials and PubMed from inception to 1 June 2019. A meta-analysis was performed to compare postoperative perioperative and radiographic outcomes between DAA and PLA in THA with respect to the hospital stay, blood loss, incision length, operative time, complications, and femoral and cup component position. The Harris Hip Score (HHS) was also assessed before and after 6 months postoperatively. RESULTS: Nine eligible studies involving 22698 adult patients (DAA group, n = 2947; PLA group, n = 19751) were identified for analysis. Compared with the PLA group, the DAA group had shorter hospital stay and achieved better HHS within 6 months after operation (P < 0.05), but the HHS was no significant differences between the two groups over 6 months (P > 0.05). The DAA group had significantly longer operative time, more blood loss, and complications than the PLA group (P < 0.05). In addition, the femoral component positioned in neutral and cup component inclination angle was comparable between both groups (P > 0.05); however, cup component anteversion angle was significantly larger in the PLA group (P < 0.05). CONCLUSION: Patients in the DAA group had higher HHS within 6 months and shorter hospital stay. The DAA could offer rapid early functional recovery after THA compared with the PLA. However, the DAA group often required longer operative time and had more blood loss. Furthermore, there was a higher early complication rate. Therefore, we believe that the direct anterior approach was a more difficult technique. The surgeon should be a well-trained joint surgeon with extensive prior hip replacement experience before performing THA through a DAA, and DAA was not suitable for beginners performing THA. In addition, we did not observe the difference with regard to the femoral component position and cup component inclination angle except for the smaller cup component anteversion angle in DAA group.
format Online
Article
Text
id pubmed-7816494
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-78164942021-01-22 Direct anterior approach versus posterolateral approach in total hip arthroplasty: a meta-analysis of results on early post-operative period Sun, Xuedong Zhao, Xueli Zhou, Licheng Su, Zheng J Orthop Surg Res Systematic Review BACKGROUND: This study was performed to compare the advantage and disadvantage of posterolateral approach (PLA) and direct anterior approach (DAA) in total hip arthroplasty (THA). METHODS: Relevant trials were identified via a search of the Cochrane Central Register of Controlled Trials and PubMed from inception to 1 June 2019. A meta-analysis was performed to compare postoperative perioperative and radiographic outcomes between DAA and PLA in THA with respect to the hospital stay, blood loss, incision length, operative time, complications, and femoral and cup component position. The Harris Hip Score (HHS) was also assessed before and after 6 months postoperatively. RESULTS: Nine eligible studies involving 22698 adult patients (DAA group, n = 2947; PLA group, n = 19751) were identified for analysis. Compared with the PLA group, the DAA group had shorter hospital stay and achieved better HHS within 6 months after operation (P < 0.05), but the HHS was no significant differences between the two groups over 6 months (P > 0.05). The DAA group had significantly longer operative time, more blood loss, and complications than the PLA group (P < 0.05). In addition, the femoral component positioned in neutral and cup component inclination angle was comparable between both groups (P > 0.05); however, cup component anteversion angle was significantly larger in the PLA group (P < 0.05). CONCLUSION: Patients in the DAA group had higher HHS within 6 months and shorter hospital stay. The DAA could offer rapid early functional recovery after THA compared with the PLA. However, the DAA group often required longer operative time and had more blood loss. Furthermore, there was a higher early complication rate. Therefore, we believe that the direct anterior approach was a more difficult technique. The surgeon should be a well-trained joint surgeon with extensive prior hip replacement experience before performing THA through a DAA, and DAA was not suitable for beginners performing THA. In addition, we did not observe the difference with regard to the femoral component position and cup component inclination angle except for the smaller cup component anteversion angle in DAA group. BioMed Central 2021-01-19 /pmc/articles/PMC7816494/ /pubmed/33468181 http://dx.doi.org/10.1186/s13018-021-02218-7 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Systematic Review
Sun, Xuedong
Zhao, Xueli
Zhou, Licheng
Su, Zheng
Direct anterior approach versus posterolateral approach in total hip arthroplasty: a meta-analysis of results on early post-operative period
title Direct anterior approach versus posterolateral approach in total hip arthroplasty: a meta-analysis of results on early post-operative period
title_full Direct anterior approach versus posterolateral approach in total hip arthroplasty: a meta-analysis of results on early post-operative period
title_fullStr Direct anterior approach versus posterolateral approach in total hip arthroplasty: a meta-analysis of results on early post-operative period
title_full_unstemmed Direct anterior approach versus posterolateral approach in total hip arthroplasty: a meta-analysis of results on early post-operative period
title_short Direct anterior approach versus posterolateral approach in total hip arthroplasty: a meta-analysis of results on early post-operative period
title_sort direct anterior approach versus posterolateral approach in total hip arthroplasty: a meta-analysis of results on early post-operative period
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816494/
https://www.ncbi.nlm.nih.gov/pubmed/33468181
http://dx.doi.org/10.1186/s13018-021-02218-7
work_keys_str_mv AT sunxuedong directanteriorapproachversusposterolateralapproachintotalhiparthroplastyametaanalysisofresultsonearlypostoperativeperiod
AT zhaoxueli directanteriorapproachversusposterolateralapproachintotalhiparthroplastyametaanalysisofresultsonearlypostoperativeperiod
AT zhoulicheng directanteriorapproachversusposterolateralapproachintotalhiparthroplastyametaanalysisofresultsonearlypostoperativeperiod
AT suzheng directanteriorapproachversusposterolateralapproachintotalhiparthroplastyametaanalysisofresultsonearlypostoperativeperiod