Anterior Approach of Total Hip Arthroplasty, a Systematic Review

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Haitham Abdel-Azem El-Helaly ◽  
Zeiad M Zakaria ◽  
Ahmed Essmat Abdel Mohsen
Keyword(s):  
Systematic Review ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Meta Analysis ◽  
Direct Anterior Approach ◽  
Lateral Approach ◽  
Postoperative Outcomes ◽  
Surgical Approaches ◽  
Complication Rates ◽  
Meta Analyses

Abstract Background There are 3 commonly used surgical approaches to the hip: the anterior, lateral [anterolateral (Hardinge) and direct lateral (Watson-Jones)].and posterior approaches. Each one is different from the other in anatomy, technical aspects, outcome and complications. However there is no current consensus regarding which approach is the most suitable. Aim of the Work To compare various clinical outcomes and complication rates across the 3 approaches focusing on direct anterior approach which may influence surgeon choice in the future and to identify which approach is the best for THA. Patients and Methods This systematic review and network meta-analysis were conducted following guidelines in the preferred reporting items for systematic reviews and meta-analyses (PRISMA), extension of network meta-analyses. The outcomes of interest were VAS, HHS and postoperative total complications after THA. Methods of measure for these outcomes were used according to the original studies. Results The lowest VAS pain and highest HHS after THA is the anterior approach followed by the lateral approach. The best approach class that had the lowest complications was posterior followed by the lateral approach, and the anterior approach had the highest risk of having complications after THA. Although the anterior approach had efficient postoperative outcomes, it should still be use with caution due to the high complication rates. Conclusion The best surgical approach for the lowest VAS pain and highest HHS after THA is the anterior approach followed by the lateral approach. The best approach class that had the lowest complications was posterior followed by the lateral approach, and the anterior approach had the highest risk of having complications after THA. Therefore, the use of the posterior approach is safe for THA, whereas although the anterior approach had efficient postoperative outcomes, it should still be use with caution due to the high complication rates.

scholarly journals The role of an anterior approach in the treatment of ankylosing spondylitis–associated cervical fractures: a systematic review and meta-analysis

2021 ◽  
Vol 51 (4) ◽  
pp. E9
Author(s):  
Vaidya Govindarajan ◽  
Jean-Paul Bryant ◽  
Roberto J. Perez-Roman ◽  
Michael Y. Wang
Keyword(s):  
Systematic Review ◽  
Ankylosing Spondylitis ◽  
Anterior Approach ◽  
Meta Analysis ◽  
Neurological Function ◽  
Surgical Approaches ◽  
Complication Rates ◽  
Neurological Improvement ◽  
Cervical Fractures ◽  
Anterior Posterior

OBJECTIVE Cervical fractures in patients with ankylosing spondylitis can have devastating neurological consequences. Currently, several surgical approaches are commonly used to treat these fractures: anterior, posterior, and anterior-posterior. The relative rarity of these fractures has limited the ability of surgeons to objectively determine the merits of each. The authors present an updated systematic review and meta-analysis investigating the utility of anterior surgical approaches relative to posterior and anterior-posterior approaches. METHODS After a comprehensive literature search of the PubMed, Cochrane, and Embase databases, 7 clinical studies were included in the final qualitative and 6 in the final quantitative analyses. Of these studies, 6 compared anterior approaches with anterior-posterior and posterior approaches, while 1 investigated only an anterior approach. Odds ratios and 95% confidence intervals were calculated where appropriate. RESULTS A meta-analysis of postoperative neurological improvement revealed no statistically significant differences in gross rates of neurological improvement between anterior and posterior approaches (OR 0.40, 95% CI 0.10–1.59; p = 0.19). However, when analyzing the mean change in neurological function, patients who underwent anterior approaches had a significantly lower mean change in postoperative neurological function relative to patients who underwent posterior approaches (mean difference [MD] −0.60, 95% CI −0.76 to −0.45; p < 0.00001). An identical trend was seen between anterior and anterior-posterior approaches; there were no statistically significant differences in gross rates of neurological improvement (OR 3.05, 95% CI 0.84–11.15; p = 0.09). However, patients who underwent anterior approaches experienced a lower mean change in neurological function relative to anterior-posterior approaches (MD −0.46, 95% CI −0.60 to −0.32; p < 0.00001). There were no significant differences in complication rates between anterior approaches, posterior approaches, or anterior-posterior approaches, although complication rates trended lower in patients who underwent anterior approaches. CONCLUSIONS The results of this review and meta-analysis demonstrated the varying benefits of anterior approaches relative to posterior and anterior-posterior approaches in treatment of cervical fractures associated with ankylosing spondylitis. While reports demonstrated lower degrees of neurological improvement in anterior approaches, they may benefit patients with less-severe injuries if lower complication rates are desired.

scholarly journals Outcomes and Complications After Primary Arthroscopic Suprapectoral Versus Open Subpectoral Biceps Tenodesis for Superior Labral Anterior-Posterior Tears or Biceps Abnormalities: A Systematic Review and Meta-analysis

2020 ◽  
Vol 8 (8) ◽  
pp. 232596712094532
Author(s):  
Zi Jun Deng ◽  
Clark Yin ◽  
Joseph Cusano ◽  
Hussein Abdul-Rassoul ◽  
Emily J. Curry ◽  
...  
Keyword(s):  
Systematic Review ◽  
Constant Score ◽  
Meta Analysis ◽  
Complication Rates ◽  
Biceps Tenodesis ◽  
Weighted Mean ◽  
Meta Analyses ◽  
Subpectoral Biceps Tenodesis ◽  
Popeye Deformity ◽  
Anterior Posterior

Background: Biceps tenodesis is a surgical treatment for both superior labral anterior-posterior (SLAP) tears and long head of the biceps tendon (LHBT) abnormalities. Biceps tenodesis can be performed either above or below the pectoralis major tendon with arthroscopic or open techniques. Purpose: To analyze the outcomes and complications comparing primary arthroscopic suprapectoral versus open subpectoral biceps tenodesis for either SLAP tears or LHBT disorders. Study Design: Systematic review; Level of evidence, 4. Methods: A search strategy based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) protocol was used to include 18 articles (471 patients) from a total of 974 articles identified. Overall exclusion criteria included the following: non–English language, non–full text, biceps tenodesis with concomitant rotator cuff repair, review articles, meta-analyses, and case reports. Data were extracted and analyzed according to procedure type and tenodesis location: arthroscopic suprapectoral biceps tenodesis (295 patients) versus open subpectoral bicepts tenodesis (176 patients). Results: For arthroscopic suprapectoral biceps tenodesis, the weighted mean American Shoulder and Elbow Surgeons (ASES) score was 90.0 (97 patients) and the weighted mean Constant score was 88.7 (108 patients); for open subpectoral biceps tenodesis, the mean ASES score was 91.1 (199 patients) and mean Constant score was 84.7 (65 patients). Among the 176 patients who underwent arthroscopic biceps tenodesis, there was an overall complication rate of 9.1%. Among the 295 patients who underwent open biceps tenodesis, there was an overall complication rate of 13.5%. Both residual pain (5.7% vs 4.7%, respectively) and Popeye deformity (1.7% vs 1.0%, respectively) rates were similar between the groups. Open subpectoral biceps tenodesis had higher reoperation (3.0% vs 0.0%, respectively), wound complication (1.0% vs 0.0%, respectively), and nerve injury (0.7% vs 0.0%, respectively) rates postoperatively. A meta-analysis of 3 studies demonstrated that both methods had similar ASES scores ( P = .36) as well as all-cause complication rates (odds ratio, 0.76 [95% CI, 0.13-4.48]; P = .26). Conclusion: Patients undergoing arthroscopic suprapectoral biceps tenodesis for either SLAP tears or LHBT abnormalities had similar outcome scores and complication rates compared with those undergoing open subpectoral biceps tenodesis. Additionally, both residual pain and Popeye deformity rates were similar between the 2 groups.

scholarly journals Surgical approach for fracture of distal humerus: Posterior vs lateral

2020 ◽  
Author(s):  
Michela Saracco ◽  
Alessandro Smimmo ◽  
Davide De Marco ◽  
Osvaldo Palmacci ◽  
Giuseppe Malerba ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Radial Nerve ◽  
Posterior Approach ◽  
Age Distribution ◽  
Young Patients ◽  
Lateral Approach ◽  
Humeral Fractures ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Complication Rates

Humeral fractures have an incidence of 3-5% and a bimodal age distribution. They may occur in young patients after highenergy traumas or in elderly osteoporotic patients after low-energy injuries. In nondisplaced fractures or in elderly patients, humeral fractures are treated by conservative methods. Open reduction and internal fixation (ORIF) should be the treatment of choice in case of multi-fragmentary fractures associated with radial nerve palsy or not. ORIF is usually regarded as the gold standard treatment, but, depending on the different types of fracture, the surgical approach can change. In this review, we compare results and complication rates between lateral and posterior surgical approaches in the management of extraarticular distal humeral shaft fractures. An internet-based literature research was performed on Pubmed, Google Scholars and Cochrane Library. 265 patients were enrolled: 148 were treated by lateral or antero-lateral approach, while 117 by posterior or postero-lateral approach. The literature shows that no differences between the posterior and lateral approach exist. Certainly, the posterior approach offers undoubted advantages in terms of exposure of the fracture and visualization of the radial nerve. In our opinion, the posterior approach may also allow better management of complex and multi-fragmentary fractures.

scholarly journals A systematic review and meta-analysis of complications following the posterior and lateral surgical approaches to total hip arthroplasty

2015 ◽  
Vol 97 (1) ◽  
pp. 11-16 ◽  
Author(s):  
JR Berstock ◽  
AW Blom ◽  
AD Beswick
Keyword(s):  
Systematic Review ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Randomised Trial ◽  
Lateral Approach ◽  
Surgical Approaches ◽  
Controlled Trials ◽  
Total Hip ◽  
Randomised Controlled

Introduction Total hip arthroplasty is one of the most commonly performed orthopaedic procedures. Despite this, medical evidence to inform the choice of surgical approach is lacking. Currently in the UK, the two most frequently performed approaches to the hip are the posterior and the direct lateral. Methods This systematic review was performed according to Cochrane guidelines following an extensive search for prospective controlled trials published in any language before January 2014. Of the 728 records identified from searches, 6 prospective studies (including 3 randomised controlled trials) involving 517 participants provided data towards this review. Findings Compared with the lateral approach, the posterior approach conferred a significant reduction in the risk of Trendelenburg gait (odds ratio [OR]: 0.31, p=0.0002) and stem malposition (OR: 0.24, p=0.02), and a non-significant reduction in dislocation (OR: 0.37, p=0.16) and heterotopic ossification (OR: 0.41, p=0.13). Neither approach conferred a functional advantage. We draw attention to the paucity of evidence and the need for a further randomised trial.

Sign in / Sign up

Export Citation Format

Share Document