scholarly journals Direct anterior approach (DAA) vs. conventional approaches in total hip arthroplasty: A RCT meta-analysis with an overview of related meta-analyses

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255888 ◽  
Author(s):  
Philip Lazaru ◽  
Simon Bueschges ◽  
Nikolai Ramadanov
Keyword(s):  
Total Hip Arthroplasty ◽  
Anterior Approach ◽  
Meta Analysis ◽  
Operation Time ◽  
Direct Anterior Approach ◽  
Risk Of Bias ◽  
Intraoperative Blood Loss ◽  
Short Term ◽  
Incision Length ◽  
Meta Analyses

Objectives Several systematic reviews and meta-analyses on short-term outcomes between total hip arthroplasty (THA) through direct anterior approach (DAA) compared to THA through conventional (including anterior, anterolateral, lateral transgluteal, lateral transtrochanteric, posterior, and posterolateral) approaches (CAs) in treatment of hip diseases and fractures showed contradicting conclusions. Our aim was to draw definitive conclusions by conducting both a fixed and random model meta-analysis of quality randomized controlled trials (RCTs) and by comparison with related meta-analyses. Design We performed a systematic literature search up to May 2020 to identify RCTs, comparing THA through DAA with THA through CAs and related meta-analyses. We conducted risk of bias and level of evidence assessment in accordance with the Cochrane’s Risk of Bias 2 tool and with the guidelines of the Centre for Evidence-Based Medicine. We estimated mean differences (MD) with 95% confidence intervals (CI) through fixed and random effects models, using the DerSimonian and Laird method. Heterogeneity was assessed using tau-square (τ2). Our conclusions take into account the overall results from related meta-analyses. Results Nine studies on THA through DAA met the criteria for final meta-analysis, involving 998 patients. Three studies were blinded RCTs with a level I evidence, the other 6 studies were non-blinded RCTs with a level II evidence. We came to the following results for THA through DAA compared to THA through CAs: operation time (I2 = 92%, p<0.01; fixed: MD = 15.1, 95% CI 13.1 to 17.1; random: MD = 18.1, 95% CI 8.6 to 27.5); incision length (I2 = 100%, p<0.01; fixed: MD = -2.9, 95% CI -3.0 to -2.8; MD = -1.1, 95% CI -4.3 to 2.0); intraoperative blood loss (I2 = 87%, p<0.01; fixed: MD = 51.5, 95% CI 34.1 to 68.8; random: MD = 51.9, 95% CI -89.8 to 193.5); VAS 1 day postoperatively (I2 = 79%, p = 0.03; fixed: MD = -0.8, 95% CI -1.2 to -0.4; random: MD = -0.9, 95% CI -2.0 to 0.15); HHS 3 months postoperatively (I2 = 52%, p = 0.08; fixed: MD = 2.8, 95% CI 1.1 to 4.6; random: MD = 3.0, 95% CI -0.5 to 6.5); HHS 6 months postoperatively (I2 = 0%, p = 0.67; fixed: MD = 0.9, 95% CI -1.1 to 2.9; random: MD = 0.9, 95% CI -1.1 to 2.9); HHS 12 months postoperatively (I2 = 0%, p = 0.79; fixed: MD = 0.7, 95% CI -0.9 to 2.4; random: MD = 0.7, 95% CI -0.9 to 2.4). We compared our findings with 7 related meta-analyses. Conclusions Considering the results of our meta-analysis and the review of related meta-analyses, we can conclude that short-term outcomes of THA through DAA were overall better than THA through CAs. THA through DAA had a shorter incision length, a tendency towards a lower pain VAS 1 day postoperatively and better early postoperative functional outcome than THA through CAs. The intraoperative blood loss showed indifferent results. THA through DAA had a longer operation time than THA through CAs.

Direct anterior approach has short-term functional benefit and higher resource requirements compared with the posterior approach in primary total hip arthroplasty

2021 ◽  
Vol 103-B (6) ◽  
pp. 1078-1087 ◽  
Author(s):  
Mohamed E. Awad ◽  
Brendan J. Farley ◽  
Gamal Mostafa ◽  
Khaled J. Saleh
Keyword(s):  
Total Hip Arthroplasty ◽  
Functional Outcome ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Direct Anterior Approach ◽  
Short Term ◽  
The Mean ◽  
One Year ◽  
Meta Analyses

Aims It has been suggested that the direct anterior approach (DAA) should be used for total hip arthroplasty (THA) instead of the posterior approach (PA) for better early functional outcomes. We conducted a value-based analysis of the functional outcome and associated perioperative costs, to determine which surgical approach gives the better short-term outcomes and lower costs. Methods This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and the Cochrane Handbook. Several online databases were searched. Non-stratified and stratified meta-analyses were conducted to test the confounding biases in the studies which were included. The mean cost and probability were used to determine the added costs of perioperative services. Results The DAA group had significantly longer operating times (p < 0.001), reduced length of hospital stay by a mean of 13.4 hours (95% confidence interval (CI) 9.12 to 18; p < 0.001), and greater blood loss (p = 0.030). The DAA group had significantly better functional outcome at three (p < 0.001) and six weeks (p = 0.006) postoperatively according to the Harris Hip Score (HHS). However, there was no significant difference between the groups for the HHS at six to eight weeks (p = 0.230), 12 weeks (p = 0.470), six months (p = 0.740), and one year (p = 0.610), the 12-Item Short Form Survey (SF-12) physical score at six weeks (p = 0.580) and one year (p = 0.360), SF-12 mental score at six weeks (p = 0.170) and one year (p = 0.960), and University of California and Los Angeles (UCLA) activity scale at 12 weeks (p = 0.250). The mean non-stratified and stratified difference in costs for the operating theatre time and blood transfusion were $587.57 (95% CI 263.83 to 1,010.29) to $887.04 (95% CI 574.20 to 1,298.88) and $248.38 (95% CI 1,003.40 to 1,539.90) to $1,162.41 (95% CI 645.78 to 7,441.30), respectively, more for the DAA group. However, the mean differences in costs for the time in hospital were $218.23 and $192.05, respectively, less for the DAA group. Conclusion The use of the DAA, rather than the PA, in THA has earlier benefits for function and pain. However, these are short-lasting, with no significant differences seen at later intervals. In addition the limited benefits were obtained with higher cumulative costs for DAA. Cite this article: Bone Joint J 2021;103-B(6):1078–1087.

scholarly journals Supercapsular percutaneously-assisted total hip (SuperPath) versus posterolateral total hip arthroplasty in bilateral osteonecrosis of the femoral head: a pilot clinical trial

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Weikun Meng ◽  
Zhong Huang ◽  
Haoyang Wang ◽  
Duan Wang ◽  
Zeyu Luo ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Short Term ◽  
Incision Length ◽  
Total Hip ◽  
Hip Function

Abstract Background The supercapsular percutaneously-assisted total hip arthroplasty (SuperPath) was proposed to be minimally invasive and tissue sparing with possible superior postoperative outcomes to traditional approaches of total hip arthroplasty (THA). Here, we compared the short-term outcomes of staged THA with the SuperPath or through posterolateral approach (PLA) for bilateral osteonecrosis of the femoral head (ONFH). Methods Patients with bilateral late-stage ONFH were prospectively recruited from our department from March 2017 to March 2018. Staged bilateral THAs with one side SuperPath and the other side PLA were performed consecutively in the same patients with right and left hips alternating within approaches. The average time interval between the staged THAs was 3 months. Perioperative status (operation time, incision length, intraoperative blood loss, soft tissue damage, and length of hospital stay) and postoperative function (range of motion, pain, and hip function) were recorded and compared between the SuperPath and PLA approaches within 12-month postoperatively. Results Four male patients (age, 51.00 ± 4.54; BMI, 21.49 ± 1.73) with bilateral alcohol-induced ONFH (Ficat III/IV) were followed up over 12 months postoperatively. Compared with the PLA, the SuperPath yielded shorter incision length (7.62 vs. 11.12 cm), longer operation time (103.25 vs. 66.50 min), more blood loss (1108.50 vs. 843.50 ml), deficient abduction angle of the acetabular cup (38.75° vs. 44.50°), and inferior early-term hip function (Harris hip score, 72.50 vs. 83.25) at 12-month postoperatively. Soft tissue damage, length of hospital stay, postoperative pain, postoperative range of motion, and 12-month patient satisfaction were comparable between both approaches. Conclusion The SuperPath may be a minimally invasive technique but the present study shows less favorable short-term outcomes than PLA for total hip arthroplasty in osteonecrosis of the femoral head. More investigations are required to provide convincing favorable evidences of the SuperPath over other traditional THA approaches. Trial registration information The trial was retrospectively registered in https://www.researchregistry.com (No. Researchregistry4993) on July 04, 2019. The first participant was enrolled on March 13, 2017.

scholarly journals Bilateral simultaneous total hip arthroplasty: comparison of treatment outcome between the direct anterior approach and the posterolateral approach

2019 ◽  
Author(s):  
Shuo Feng ◽  
Ning Jian Sun ◽  
Yu Zhang ◽  
Ye Zhang ◽  
Yang Xiang Chen ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Operation Time ◽  
Direct Anterior Approach ◽  
Posterolateral Approach ◽  
Joint Function ◽  
Total Hip ◽  
Postoperative Drainage

Abstract Background There are many surgical approaches for total hip arthroplasty. In recent years, direct anterior approach (DAA) has been highly praised by many scholars, and it has been widely reported that it has a good curative effect, such as fast recovery. Whether the surgical results and patient satisfaction can reach or exceed the traditional posterolateral approach has been controversial. We hypothesized that the treatment outcome of the direct anterior approach (DAA) approach is superior to the traditional posterolateral approach (PLA). Methods From January 2015 to April 2017, 20 patients (40 hips) were randomly divided into posterolateral approach (PLA) group and direct anterior approach (DAA) group. Record the operation time on both sides, postoperative drainage, prosthesis position, and complications, the functional recovery of hip joint was evaluated by D'Aubigne-Postel score, and the postoperative pain was evaluated by VAS score. Gait parameters were measured before surgery and at 3 and 6 months after surgery, and the patients were asked which side they preferred subjectively after surgery. Results When compared with the PLA group, the DAA group had a shorter incision length (11.4 vs 14.72 cm, P<0.001), shorter intraoperative blood loss (184.05vs 219.00 mL, P<0.001), shorter postoperative drainage volume (105.35 vs 154.10 mL, P<0.001), and lower VAS scores. However, the PLA had shorter operative times (82.20 vs 67.3 min, P<0.001). There was no significant difference in acetabular inclination (39.72 vs 40.92 °, P=0.069), and acetabular anteversion (17.41 vs 17.69°, P=0.663) between the two groups. Joint function recovery: The D'Aubigne-Postel scores of the hip joints in the DAA group vs PLA group at 1, 3, and 6 months after surgery were (8.2, 11.5, 16.5) vs (7.65, 11.45, 16.9). The difference in the 1, 3month was statistically significant (P=0.012, P=0.038), however, this difference disappeared in the 6th month(P=0.072). Conclusions Compared with the PLA, the DAA has the advantages of shorter operation time, smaller incision, less bleeding, less pain, better gait performance and faster recovery of joint function, but patients subjectively preferred the traditional PLA.

Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review

2020 ◽  
Vol 30 (6) ◽  
pp. 662-672 ◽  
Author(s):  
Mohamed Sarraj ◽  
Aaron Chen ◽  
Seper Ekhtiari ◽  
Luc Rubinger
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Operative Time ◽  
Direct Anterior Approach ◽  
Short Term ◽  
Total Hip ◽  
Standard Table

Background: The direct anterior approach (DAA) for total hip arthroplasty (THA) was originally performed with a supine patient on a specialised traction table, but the approach can also be performed on a standard operating table. Despite cost and safety implications, there are few studies directly comparing these techniques and table choice remains largely surgeon preference. The purpose of this review was to compare the clinical outcomes and complication profiles of traction and standard table DAA for primary THA. Methods: The authors searched databases for relevant studies, screening in duplicate. Study quality was assessed using MINORS criteria or Cochrane Risk of Bias Tool. Data pertaining to patient demographics, clinical outcomes, and complications were abstracted. Results: Of 3085 initial titles, 44 studies containing a total 26,353 patients were included and analysed. Mean operative time was 70.9 ± 21.2 minutes for standard table ( n = 4402) and 100.1 ± 32.6 minutes for traction table ( n = 3518). Mean estimated blood loss was 382.3 ± 246.4 mL for standard ( n = 2992) and 531.7 ± 364.3 mL for traction table ( n = 2675). Intra-operative fracture rate was 1.3% for standard table ( n = 3940) and 1.7% for traction table ( n = 8386). Complication rates including revisions, dislocations and peri-prosthetic fractures were qualitatively similar between traction and standard table studies. Conclusion: Standard table and traction table DAA have similar outcomes and complications. Both techniques offer the short-term advantages of DAA when compared to other THA approaches. However, the standard table technique may offer perioperative advantages including decreased blood loss, shorter operative time, and fewer intraoperative fractures. In the context of rising global healthcare costs and lack of access to specialised orthopaedic traction tables, this review at minimum confirms the short-term safety of standard table DAA THA and prompts the need for future studies to directly compare these techniques.

scholarly journals Laparoscopic vs. Open Repeat Hepatectomy for Recurrent Liver Tumors: A Propensity Score–Matched Study and Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Jia-Feng Chen ◽  
Xiu-Tao Fu ◽  
Zheng Gao ◽  
Ying-Hong Shi ◽  
Zheng Tang ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Propensity Score ◽  
Liver Tumors ◽  
Meta Analysis ◽  
Operation Time ◽  
Repeat Hepatectomy ◽  
Intraoperative Blood Loss ◽  
Short Term ◽  
Lymphocyte Ratio ◽  
Matched Study

Background: It remains unclear whether the short-term benefits of laparoscopic repeat hepatectomy (LRH) accrue to patients with recurrent liver tumors. The present study aimed to report our own center's experience and perform a meta-analysis to evaluate the safety and feasibility of LRH in comparison with open repeat hepatectomy (ORH) for treating recurrent liver tumors.Patients and Methods: A propensity score–matched study was performed including 426 patients receiving LRH or ORH for recurrent hepatocellular carcinoma between January 2017 and December 2018. Surgical outcomes and perioperative inflammation-based markers, including monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune–inflammation index were collected from medical records and analyzed. Additionally, a systematic literature review was performed to identify relevant studies in PubMed, EMBASE, Web of Science, and Cochrane library databases up to October 1, 2020. Information including patient demographics, pathologic characteristics, and short-term outcomes was extracted and analyzed using random- or fixed-effects models.Results: Of 68 LRHs, 57 were matched with an ORH finally. Our study demonstrated that LRH was significantly associated with less intraoperative blood loss (50 vs. 100 mL; P &lt; 0.001), lower rate of hepatic inflow occlusion (10.52 vs. 33.3%; P = 0.003), and shorter postoperative hospital stay (5 vs. 6 days; P = 0.001) after 1:1 propensity score matching. The operation time, rate of blood transfusion, and postoperative complications were similar between the two groups. Moreover, all four inflammation-based markers were significantly lower in LRH group on postoperative day 1. In the meta-analysis, a total of 12 studies comprising 1,315 patients receiving repeat hepatectomy met the selection criteria. Similar to our own study, the meta-analysis showed shorter hospital stay [standard mean difference (SMD) = −0.51, 95% confidence interval (CI) = −0.79 to −0.22, P &lt; 0.001], less intraoperative blood loss (SMD = −0.79, 95% CI = −1.11 to −0.47, P &lt; 0.001), and lower rate of major postoperative complications [odds ratio (OR) = 0.35, 95% CI = 0.19–0.66, P = 0.001] in the LRH group. There was no difference in the field of overall postoperative complication and operation time between LRH and ORH groups.Conclusion: Compared with ORH, LRH results in relatively better surgical outcomes and faster postoperative recovery. It could be considered a feasible and effective option for the treatment of recurrent liver tumors.

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