scholarly journals Clinical, Functional and Radiographic Outcomes of Primary Total Hip Arthroplasty between Direct Anterior Approach and Posterior Approach: a Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Linbo Peng ◽  
Yi Zeng ◽  
Yuangang Wu ◽  
Junfeng Zeng ◽  
Yuan Liu ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Direct Anterior Approach ◽  
Total Hip ◽  
Randomized Controlled ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Primary Total Hip Arthroplasty

Abstract Background: The purpose of this systematic review and meta-analysis was to compare the clinical, functional and radiographic outcomes of primary total hip arthroplasty between the direct anterior approach and posterior approach. Methods: We searched the PubMed, EMBASE databases and Cochrane library from the inception dates to November 1, 2019. And we also searched for the meta-analysis which was published in the past for randomized controlled trials. Results: A total of 7 randomized controlled trials with 600 participants fulfilled the inclusion criteria. Among these, 301 and 299 patients were in the DAA and PA groups, respectively. DAA was associated with a longer surgery time by a mean of 13.74 min (95% CI 6.88 to 20.61, p < 0.0001, I2=93%). Postoperative early functional outcomes were significantly better in the DAA group than PA group such as Visual Analogue Scale (VAS) postoperative 1 day (MD=-0.65, 95% CI -0.91 to -0.38,p < 0.00001, I2=0%), VAS score postoperative 2 days (MD=-0.67, 95% CI -1.34 to -0.01, p =0.05,I2=88%) and Harris Hip Score (HHS) postoperative 6 weeks(MD=6.05, 95% CI 1.14 to 10.95, p =0.02, I2=52%).There was no significant difference between the DAA and PA groups at length of incision, length of stay(LOS), blood loss, transfusion rates or complication rates. We found no significant difference between the two groups about late functional outcomes such as VAS score postoperative 12 months or HHS scores postoperative 3, 6, 12 months. A significant difference in Radiographic outcomes can not be detected too. Conclusions: DAA needs longer surgery time than PA in primary total hip arthroplasty. The DAA offers better early functional recovery than PA. There is no significant difference between the two groups in terms of other clinical, complication, late functional and radiographic outcomes. The evidence about the superiority of DAA is insufficient, which needs more research.

scholarly journals Clinical, Functional and Radiographic Outcomes of Primary Total Hip Arthroplasty between Direct Anterior Approach and Posterior Approach: a Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Linbo Peng ◽  
Yi Zeng ◽  
Yuangang Wu ◽  
Junfeng Zeng ◽  
Yuan Liu ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Direct Anterior Approach ◽  
Total Hip ◽  
Randomized Controlled ◽  
Vas Score ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Primary Total Hip Arthroplasty

Abstract Background: The purpose of this systematic review and meta-analysis was to compare the direct anterior approach and posterior approach for primary total hip arthroplasty in terms of the clinical, functional and radiographic outcomes. Methods: We searched the PubMed and EMBASE databases and Cochrane Library from their inception to November 1, 2019. We searched for previously published articles and meta-analyses of randomized controlled trials. Results: A total of 7 randomized controlled trials with 600 participants met the inclusion criteria. Among these patients, 301 and 299 were included in the DAA and PA groups, respectively. The DAA was associated with a longer surgery by a mean duration of 13.74 min (95% CI 6.88 to 20.61, p < 0.0001, I 2 =93%). The postoperative early functional outcomes were significantly better in the DAA group than in the PA group, such as the Visual Analogue Scale (VAS) score at 1 day postoperatively (MD=-0.65, 95% CI -0.91 to -0.38, p < 0.00001, I 2 =0%), VAS score at 2 days postoperatively (MD=-0.67, 95% CI -1.34 to -0.01, p =0.05, I 2 =88%) and Harris Hip Score (HHS) at 6 weeks postoperatively (MD=6.05, 95% CI 1.14 to 10.95, p =0.02, I 2 =52%). There was no significant difference between the DAA and PA groups in the length of the incision, hospital length of stay (LOS), blood loss, transfusion rates or complication rates. We found no significant difference between the two groups regarding late functional outcomes, such as the VAS score at 12 months postoperatively or the HHS scores at 3, 6, and 12 months postoperatively. A significant difference in the radiographic outcomes was not detected. Conclusions: The DAA requires a longer surgery time than does the PA in primary total hip arthroplasty. The DAA yields better early functional recovery than does the PA. There was no significant difference between the two groups in terms of other clinical, complication-related, late functional or radiographic outcomes. The evidence on the superiority of the DAA is insufficient and needs to be studied further.

scholarly journals Clinical, Functional and Radiographic Outcomes of Primary Total Hip Arthroplasty between Direct Anterior Approach and Posterior Approach: a Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Linbo Peng ◽  
Yi Zeng ◽  
Yuangang Wu ◽  
Junfeng Zeng ◽  
Yuan Liu ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Direct Anterior Approach ◽  
Total Hip ◽  
Randomized Controlled ◽  
Vas Score ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Primary Total Hip Arthroplasty

Abstract Background: The purpose of this systematic review and meta-analysis was to compare the direct anterior approach and posterior approach for primary total hip arthroplasty in terms of the clinical, functional and radiographic outcomes.Methods: We searched the PubMed and EMBASE databases and Cochrane Library from their inception to November 1, 2019. We searched for previously published articles and meta-analyses of randomized controlled trials.Results: A total of 7 randomized controlled trials with 600 participants met the inclusioncriteria. Among these patients, 301 and 299 were included in the DAA and PA groups, respectively. The DAA was associated with a longer surgery by a mean duration of 13.74 min (95% CI 6.88 to 20.61, p < 0.0001, I2=93%). The postoperative early functional outcomes were significantly better in the DAA group than in the PA group, such as the Visual Analogue Scale (VAS) score at 1 day postoperatively (MD=-0.65, 95% CI -0.91 to -0.38, p < 0.00001, I2=0%), VAS score at 2 days postoperatively (MD=-0.67, 95% CI -1.34 to -0.01, p =0.05, I2=88%) and Harris Hip Score (HHS) at 6 weeks postoperatively (MD=6.05, 95% CI 1.14 to 10.95, p =0.02, I2=52%). There was no significant difference between the DAA and PA groups in the length of the incision, hospital length of stay (LOS), blood loss, transfusion rates or complication rates. We found no significant difference between the two groups regarding late functional outcomes, such as the VAS score at 12 months postoperatively or the HHS scores at 3, 6, and 12 months postoperatively. A significant difference in the radiographic outcomes was not detected.Conclusions: The DAA requires a longer surgery time than does the PA in primary total hip arthroplasty. The DAA yields better early functional recovery than does the PA. There was no significant difference between the two groups in terms of other clinical, complication-related, late functional or radiographic outcomes. The evidence on the superiority of the DAA is insufficient and needs to be studied further.

scholarly journals A Comparison between the Outcomes of Direct Anterior and Posterior Approaches for Rates of Dislocation and Infection in Primary Total Hip Arthroplasty

2020 ◽  
Vol 10 (1) ◽  
pp. 194-199
Author(s):  
Zohair M. Ahmed ◽  
Hamid A. Mahmud ◽  
Imad M. Rasul
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Lower Incidence ◽  
Direct Anterior Approach ◽  
Total Hip ◽  
Significant Difference ◽  
Lower Incidence Rate ◽  
A Prospective Study ◽  
Primary Total Hip Arthroplasty

Background: Direct anterior hip replacement is a slightly aggressive surgical procedure but potentially widespread. It involves opening on the front of the hip to allow the joint to be substituted by moving muscles aside along their ordinary tissue planes without removing any tendons. Nevertheless, there is diminutive consent concerning the threats and profits of this method compared to the posterior approach (PA) regarding the rates of dislocation and infection. Methods: This research is a prospective study conducted in Erbil city from September 2015 to September 2017 on 57 patients, including 28 females and 29 males, with primary total hip arthroplasty (THA). Twenty-nine patients were enrolled in the direct anterior approach (DAA: First group), and 28 patients were registered in the PA group (PA: Second group). Their age ranged between 49 and 80 years, and the regular follow-up was 12 months for all patients. Results: It was found that using the DAA, there was a significantly (P ≤ 0.05) lower incidence rate of dislocation in patients undergoing THA than the PA. No significant difference in the rates of infection was noticed between both groups. However, slightly shorter operational time and extent of the incision were noticed in the DAA group, and less blood loss was found in the PA group (non-significant). Conclusion: We realized that DAA has a clear advantage over PA regarding the lower incidence in the dislocation risk and without variance in the infection rates.

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