A prospective randomised comparison of earlier function after total hip arthroplasty with a mini posterior approach or supercapsular percutaneously-assisted total hip approach: a gait analysis study

Корыткин, А. А.; moudni, Yo. M. El; Novikova, Yana S; Ковалдов, К А; Morozova, E.A.

doi:10.1177/11207000211018440

Cited by 6 publications

(39 citation statements)

References 20 publications

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“…We identified 2130 potential studies from database searches, of which 63 studies 8 , 9 , 11 , 12 , 13 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 were eligible for inclusion (…”

Section: Resultsmentioning

confidence: 99%

“…A total of 50 studies 9 , 12 , 37 , 38 , 39 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 56 , 57 , 59 , 60 , 61 , 62 , 63 , 64 , 66 , 67 , 68 , 69 , 71 , 73 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 89 , 90 , 91 , 92 (79%) with 3882 participants (80%) reported on hip score change from baseline to end point ( Figure 3 and Figure 5 ). Compared with DLA, DAA (MD, 4.04; 95% CI, 1.92-6.16; moderate certainty), MIS-ALA (MD, 3.00; 95% CI, 0.43-5.59; moderate certainty), MIS-DLA (MD, 3.37; 95% CI, 1.05-5.68; moderate certainty), MIS-PA (MD, 4.46; 95% CI, 1.60-7.31; moderate certainty), PA (MD, 4.37; 95% CI, 1.87-6.88; high certainty), and SuperPath (MD, 5.00; 95% CI, 0.58-9.42; high certainty) showed significant improvement in hip score.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 26 studies 9 , 11 , 12 , 13 , 43 , 49 , 53 , 55 , 57 , 59 , 60 , 61 , 63 , 66 , 67 , 75 , 76 , 77 , 83 , 84 , 85 , 86 , 90 , 91 , 92 , 93 (41%) with 1936 participants (40%) reported on pain score change from baseline to endpoint ( Figure 3 and Figure 5 ). DLA was associated with a lower decrease in pain score than SuperPath (MD, 1.16; 95% CI, 0.13-2.20; high certainty) and MIS-DLA (MD, 0.90; 95% CI, 0.04-1.76; moderate certainty).…”

Section: Resultsmentioning

confidence: 99%

“…A total of 45 studies 9,12,13,38,39,[41][42][43][44][47][48][49][50][52][53][54][55][56][57][58][59][60][61]63,64,[66][67][68]70,72,73,[76][77][78][79][80][81][82][83][88][89][90][91]93,94 (71%) with 3437 participants (71%) reported on operation time (Figure 3 and Figure 5). PA was associated with…”

Section: Operation Timementioning

confidence: 99%

“…A total of 33 studies 9,12,13,38,39,41,45,[47][48][49][50][51][52][53][54]56,57,59,60,63,64,66,70,71,73,[76][77][78][79]82,83,88,91 (52%) with 2702 participants (56%) reported on blood loss (Figure 4 and Figure 5). DAA was associated with greater blood loss than MIS-ALA (MD, 85.…”

Section: Blood Lossmentioning

confidence: 99%

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Evaluation of Comparative Efficacy and Safety of Surgical Approaches for Total Hip Arthroplasty

Yan

Dong

et al. 2023

JAMA Netw Open

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ImportanceEach approach for primary total hip arthroplasty (THA) has a long learning curve, so a surgeon’s choice to change their preferred approach needs to be guided by clear justifications. However, current evidence does not suggest that any of the THA approaches are more beneficial than others, and the choice of approach is mainly based on the knowledge and experience of the surgeon and individual patient characteristics.ObjectiveTo assess the efficacy and safety associated with different surgical approaches for THA.Data SourcesA comprehensive search of PubMed, EMBASE, and Cochrane databases from inception to March 26, 2022; reference lists of eligible trials; and related reviews.Study SelectionRandomized clinical trials (RCTs) comparing different surgical approaches, including the 2-incision approach, direct anterior approach (DAA), direct lateral approach (DLA), minimally invasive direct lateral approach (MIS-DLA), minimally invasive anterolateral approach (MIS-ALA), posterior approach (PA), minimally invasive posterior approach (MIS-PA), and supercapsular percutaneously assisted total hip arthroplasty (SuperPath), for primary THA.Data Extraction and SynthesisFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 2 reviewers independently extracted data on study participants, interventions, and outcomes as well as assessed the risk of bias using the Cochrane risk of bias tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist framework was used to inform a series of random-effects network meta-analyses.Main Outcomes and MeasuresThe outcomes were hip score (range, 0-100, with higher scores indicating better overall hip condition), pain score (range, 0-100, with higher scores indicating more pain), hospitalization time, operation time, quality of life score, blood loss, cup abduction angle, and cup anteversion angle.ResultsOf 2130 retrieved studies, 63 RCTs including 4859 participants (median [IQR] age, 64.0 [60.3-66.5] years; median [IQR] percentage male, 46.74% [38.64%-54.74%]) were eligible for analysis. Eight surgical approaches were evaluated. For hip score, DAA (mean difference [MD], 4.04; 95% CI, 1.92 to 6.16; moderate certainty), MIS-ALA (MD, 3.00; 95% CI, 0.43 to 5.59; moderate certainty), MIS-DLA (MD, 3.37; 95% CI, 1.05 to 5.68; moderate certainty), MIS-PA (MD, 4.46; 95% CI, 1.60 to 7.31; moderate certainty), PA (MD, 4.37; 95% CI, 1.87 to 6.88; high certainty), and SuperPath (MD, 5.00; 95% CI, 0.58 to 9.42; high certainty) were associated with greater improvement in hip score compared with DLA. DLA was associated with lower decrease in pain score than SuperPath (MD, 1.16; 95% CI, 0.13 to 2.20; high certainty) and MIS-DLA (MD, 0.90; 95% CI, 0.04 to 1.76; moderate certainty). PA was associated with shorter operation times compared with 2-incision (MD, −23.85 minutes; 95% CI, −36.60 to −11.10 minutes; high certainty), DAA (MD, −13.94 minutes; 95% CI, −18.79 to −9.08 minutes; moderate certainty), DLA (MD, −10.50 minutes; 95% CI, −16.07 to −4.94 minutes; high certainty), MIS-ALA (MD, −6.76 minutes; 95% CI, −12.86 to −0.65 minutes; moderate certainty), and SuperPath (MD, −13.91 minutes; 95% CI, −21.87 to −5.95 minutes; moderate certainty). The incidence of 6 types of complications did not differ significantly between the approaches.Conclusions and RelevanceIn this study, moderate to high certainty evidence indicated that compared with PA, all surgical approaches except DLA were associated with similar improvements of hip score but longer operation time. DLA was associated with smaller improvement of hip score. The safety of the different approaches did not show significant differences. These findings will help health professionals and patients with better clinical decision-making and also provide references for policy makers.

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