Revision risk by using the direct superior approach (DSA) for total hip arthroplasty compared with postero-lateral approach: early nationwide results from the Dutch Arthroplasty Register (LROI)

Dooren, Bart Van; Peters, Rinne M.; Ettema, Harmen B.; Schreurs, B.W.; Steenbergen, L.N. van; Bolder, Stefan B T; Zijlstra, Wierd P

doi:10.2340/17453674.2023.11959

Cited by 5 publications

(17 citation statements)

References 24 publications

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“…Fifteen studies had an observational design, including 2 register studies (n 5 1,341 and n 5 343) 29,30 . Two studies were RCTs 26,28 . We found that most studies had a moderate level of evidence (Tables II and III; Fig.…”

Section: Quality Assessment and Methodologymentioning

confidence: 99%

“…Seven studies reported on postoperative pain scores 12,13,19,23,26,28 . Four studies 12,13,19,28 reported on immediate postoperative visual analog scale scores.…”

Section: Painmentioning

confidence: 99%

“…Four studies 12,13,19,28 reported on immediate postoperative visual analog scale scores. Xiao et al found lower pain scores for the DSA than for the standard PLA in the first 3 postoperative days (p , 0.001) 28 . By contrast, 1 high-quality study found no significant difference in pain scores between the DSA and the PLA on the first postoperative day and last day of hospitalization 12 .…”

Section: Painmentioning

confidence: 99%

“…The most commonly used instrument to measure postoperative recovery was the Harris Hip Score (HHS), where higher scores represent better physical functioning. In total, 9 studies reported on functional scores after using the HHS 10,12,17,19,21,22,25,26,28 . Mean HHSs in the early postoperative phase were better for the DSA than for the PLA in 1 high-quality study and 1 RCT 12,28 (Table V): Both studies reported significantly higher HHS for the DSA than for the PLA after 1-month follow-up.…”

Section: Physical Functionmentioning

confidence: 99%

“…In total, 9 studies reported on functional scores after using the HHS 10,12,17,19,21,22,25,26,28 . Mean HHSs in the early postoperative phase were better for the DSA than for the PLA in 1 high-quality study and 1 RCT 12,28 (Table V): Both studies reported significantly higher HHS for the DSA than for the PLA after 1-month follow-up. One RCT found significantly higher HHS for the DSA than for the PLA at 1-week follow-up 26 .…”

Section: Physical Functionmentioning

confidence: 99%

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The Direct Superior Approach in Total Hip Arthroplasty

van Dooren,

Peters,

van der Wal-Oost

et al. 2024

JBJS Reviews

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Background: Evolution of the surgical approach for total hip arthroplasty (THA) has led to the development of the minimally invasive direct superior approach (DSA). It is hypothesized that the DSA reduces postoperative pain and hospital length of stay (LOS). We aimed to provide an overview of current evidence on clinical, functional, and radiological outcomes with respect to risk of revision, complications, pain scores, physical function, operative time, LOS, blood loss, radiological outcomes, and learning curve. Methods: A comprehensive search of Medline, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar, reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension guidelines, was conducted to identify studies evaluating clinical, functional, and radiological outcomes of the DSA. Quality assessment was performed using the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. The review protocol was prospectively registered in the International Prospective Registry of Systematic Reviews. Results: Seventeen studies were included, generally of moderate quality. Qualitative synthesis evidenced accurate implant positioning, short LOS, and a short learning curve. Conflicting findings were reported for postoperative complications compared with conventional approaches. Better functional outcomes were seen in the early postoperative period than the posterolateral approach (PLA). Outcomes such as blood loss and operative time exhibited conflicting results and considerable heterogeneity. Conclusion: Based on moderate-certainty evidence, it is uncertain if the DSA provides short-term advantages over conventional approaches such as PLA. There is limited evidence on long-term outcomes post-THA using the DSA. Further studies and ongoing registry monitoring is crucial for continuous evaluation of its long-term outcomes. Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Quality Assessment and Methodologymentioning

confidence: 99%

“…Seven studies reported on postoperative pain scores 12,13,19,23,26,28 . Four studies 12,13,19,28 reported on immediate postoperative visual analog scale scores.…”

Section: Painmentioning

confidence: 99%

Section: Painmentioning

confidence: 99%

Section: Physical Functionmentioning

confidence: 99%

Section: Physical Functionmentioning

confidence: 99%

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The Direct Superior Approach in Total Hip Arthroplasty

van Dooren,

Peters,

van der Wal-Oost

et al. 2024

JBJS Reviews

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Femoral Neck Design Does Not Impact Revision Risk After Primary Total Hip Arthroplasty Using a Dual Mobility Cup

van Dooren,

Peters,

Visser

et al. 2024

Arthroplasty Today

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Low revision rate throughout the adoption of the direct superior approach in primary total hip arthroplasty: an analysis based on 1551 total hip arthroplasties from the Dutch Arthroplasty Register

Bos,

Dooren,

Peters

et al. 2024

HIP International

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Background: Recently, surgeons introduced a minimally invasive modification on the classic posterolateral approach (PLA) in total hip arthroplasty (THA): the direct superior approach (DSA). We investigated the association between surgeon’s experience and the risk of early revision of the DSA in primary THA, using data from the Dutch Arthroplasty Register (LROI). Methods: We retrieved all primary THAs performed using the DSA in 4 hospitals between 2016 and 2022 ( n = 1551). Procedures were sorted in 5 groups using the date of operation and number of previous procedures per surgeon: 1–25; 26–50; 51–75; 76–100; >100. Subsequently, data from different surgeons were pooled together and the risk of revision was calculated via a multilevel time-to-event analysis. Results: The overall revision rate was 1.5% after a mean follow-up of 2 years. Patients from the 1–25 group had comparable risks of revision compared to patients in the >100 group (hazard ratio [HR] 1.0 [CI, 0.3–3.2]). The risk for patients in groups 26–50, 51–75 and 75–100 was also not statistically different from the >100 group (resp. HR 1.5 [CI, 0.5–5.0], 1.8 [CI, 0.5–6.4] and 0.5 [CI, 0.1–4.0]). Main reasons of revision were dislocation (0.5%) and infection (0.4%). Conclusions: We did not identify an association between the surgeon’s experience and the early risk of revision for the DSA in primary THA in the Netherlands. The DSA seems safe in the early adoption phases with a low risk of revision due to dislocation and revision for all other causes.

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Revision risk by using the direct superior approach (DSA) for total hip arthroplasty compared with postero-lateral approach: early nationwide results from the Dutch Arthroplasty Register (LROI)

Cited by 5 publications

References 24 publications

The Direct Superior Approach in Total Hip Arthroplasty

The Direct Superior Approach in Total Hip Arthroplasty

Femoral Neck Design Does Not Impact Revision Risk After Primary Total Hip Arthroplasty Using a Dual Mobility Cup

Low revision rate throughout the adoption of the direct superior approach in primary total hip arthroplasty: an analysis based on 1551 total hip arthroplasties from the Dutch Arthroplasty Register

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