Does the direct anterior approach allow earlier recovery of walking following total hip arthroplasty? A randomized prospective trial using accelerometry

Bon, Gautier; Kacem, Elias Ben; Leprêtre, Pierre Marie; Weissland, Thierry; Mertl, P.; Dehl, Massinissa; Gabrion, Antoine

doi:10.1016/j.otsr.2019.02.008

Cited by 40 publications

(99 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is described as an anatomical approach [3] leading to a rapid recovery [4,5], less dislocation [6] allowing a good control of the leg length discrepancy (LLD) [7]. Publications report a lack of evidence for these benefits and significant learning difficulties associated with DAA [8,9]. Aggarwal et al [10] compared five surgical approaches and found that DAA had a significantly higher rate of complications (46.8%), as well as re-operations (4.74%).…”

Section: Introductionmentioning

confidence: 99%

Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?

Foissey

Fauvernier

Fary

et al. 2020

SICOT-J

View full text Add to dashboard Cite

Introduction: Proficiency in the direct anterior approach (DAA) as with many surgical techniques is considered to be challenging. Added to this is the controversy of the benefits of DAA compared to other total hip arthroplasty (THA) approaches. Our study aims to assess the influence of experience on learning curve and clinical results when transitioning from THA via posterior approach in a lateral position to DAA in a supine position. Methods: A consecutive retrospective series of 525 total hip arthroplasty of one senior and six junior surgeons was retrospectively analysed from May 2013 to December 2017. Clinical results were analysed and compared between the two groups and represented as a learning curve. Mean follow up was 36.2 months ± 11.8. Results: This study found a significant difference in complications between the senior and junior surgeons for operating time, infection rate, and lateral femoral cutaneous nerve (LFCN) neuropraxia. A trainee’s learning curve was an average of 10 DAA procedures before matching the senior surgeon. Of note, the early complications correlated with intraoperative fractures increased with experience in both groups. Operating time for the senior equalised after 70 cases. Dislocation rate and limb length discrepancy were excellent and did not show a learning curve between the two groups. Conclusion: DAA is a safe approach to implant a THA. There is a learning curve and initial supervision is recommended for both seniors and trainees. Level of evidence: Retrospective, consecutive case series; level IV.

show abstract

Section: Introductionmentioning

confidence: 99%

Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?

Foissey

Fauvernier

Fary

et al. 2020

SICOT-J

View full text Add to dashboard Cite

show abstract

“…The risk of hidden grouping bias is low in 3 studies [32][33][34], high in 2 studies [28,30], and inaccurate in 3 studies [29,31,35]. In three studies [32,34,35], the researchers and subjects were blinded and the risk of bias was low; in ve studies [28][29][30][31]33], the researchers and subjects were not blinded and the risk of bias was high. In the result evaluation blindness, 2 studies [32,33] had low risk bias, 5 studies [28][29][30][31]34] had high risk bias, and 1 study [35] had inaccurate risk bias.…”

Section: Search Results and The Basic Characteristics Of The Researchmentioning

confidence: 99%

“…A total of 256 related articles were retrieved according to the search strategy. By reading the title, abstract and full text, a total of 8 studies met the inclusion criteria [28][29][30][31][32][33][34][35] and were published from 2011 to 2019. 654 patients were included in these studies, including 328 patients in DAA group and 326 patients in PLA group.…”

Section: Search Results and The Basic Characteristics Of The Researchmentioning

confidence: 99%

“…The basic characteristic of the included studies can be seen in Table 1. Randomized programs included in the study include randomization schedule [29] , computer generated random numbers [35] , random envelopes [32] , and unreported [28,30,31,33,34]. In the randomly generated sequence, 3 studies are of low risk bias [29,32,35] and 5 studies are of uncertain risk bias [28,30,31,33,34].…”

Section: Search Results and The Basic Characteristics Of The Researchmentioning

confidence: 99%

“…In three studies [32,34,35], the researchers and subjects were blinded and the risk of bias was low; in ve studies [28][29][30][31]33], the researchers and subjects were not blinded and the risk of bias was high. In the result evaluation blindness, 2 studies [32,33] had low risk bias, 5 studies [28][29][30][31]34] had high risk bias, and 1 study [35] had inaccurate risk bias. The results of 5 studies [28,29,32,34,35]were complete with low risk bias.…”

Section: Search Results and The Basic Characteristics Of The Researchmentioning

confidence: 99%

See 2 more Smart Citations

A Systematic Review and Meta-analysis of Direct Anterior Approach Versus Posterolateral Approach in Total Hip Arthroplasty

Xie

Long

2021

Preprint

View full text Add to dashboard Cite

Background: To evaluate the difference of clinical results between DAA and PLA in primary THA.Methods: The PubMed , Embase and the Cochrane Library were searched by computer to collect and compare clinical randomized controlled trials of primary THA through DAA and PLA. The clinical outcome measures include operation time, total blood loss, acetabular abduction angle, acetabular anteversion angle, Harris hip score and postoperative dislocation rate. The Revman 5.3 software provided by the Cochrane Collaborat Network was used for Meta analysis of the data.Results: A total of 654 patients were included in 8 studies, including 328 patients in DAA group and 326 patients in PLA group. Meta-combined results, The number of acetabular abduction angle in DAA group is smaller than that in PLA group [MD =-0.87, 95%CI(-1.69 ~-0.04), p = 0.04], and the number of acetabular anteversion angle in DAA group is also smaller than that in PLA group [MD =-4.25, 95%CI(-4.96 ~-3.54), p < 0.00001], the differences are statistically significant. 6 weeks after operation, the Harris hip score of DAA was higher than that of PLA [MD = 5.35, 95%CI(2.38 ~ 8.32), P = 0.0004], and the difference was statistically significant. For the total Harris hip score , DAA is higher than PLA, and the difference is statistically significant [MD = 2.3, 95%CI (0.19 ~ 4.41), P = 0.03]; However, other results were not statistically significant.Conclusion: Compared with PLA, DAA can accelerate postoperative rehabilitation of patients, and at the same time can obtain better acetabular prosthesis location.

show abstract

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

Yan

Dong

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

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.

show abstract

Does the direct anterior approach allow earlier recovery of walking following total hip arthroplasty? A randomized prospective trial using accelerometry

Cited by 40 publications

References 28 publications

Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?

Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?

A Systematic Review and Meta-analysis of Direct Anterior Approach Versus Posterolateral Approach in Total Hip Arthroplasty

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

Contact Info

Product

Resources

About