Short-term outcomes vary by surgical approach in total hip arthroplasty: a network meta-analysis

Gazendam, Aaron; Bozzo, Anthony; Ekhtiari, Seper; Kruse, Colin; Hiasat, Nancy; Tushinski, Daniel; Bhandari, Mohit

doi:10.1007/s00402-021-04131-4

Cited by 24 publications

(11 citation statements)

References 44 publications

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“…Lazaru et al found that the DAA was associated with significantly better pain on postoperative day 1, nonsignificantly better short-term functional outcomes, significantly longer operative time, and no difference in intraoperative blood loss 7 . In contrast, Gazendam et al 8 and Yang et al 9 found significantly better short-term functional ability, although differences did not reach clinical importance 8 , and Yang et al found no significant differences in operative time or intraoperative blood loss 9 . The present systematic review similarly found better early postoperative functional outcomes and pain with the use of the DAA, with no significant differences in operative time and perioperative blood loss.…”

Section: Discussionmentioning

confidence: 94%

“…Although the DAA has been increasingly utilized in patients with osteoarthritis undergoing THA due to data suggesting superior early postoperative functional recovery, reduced pain, and shorter incision length, with a variable impact on operative time, complication rates, and perioperative blood loss [7][8][9][10] , it has been less widely adopted by surgeons performing HA for femoral neck fractures. The potential advantages of DAA, including earlier postoperative functional recovery and fewer prosthetic dislocations, may be helpful in a highrisk hip fracture population predisposed to an unfavorable morbidity and mortality profile.…”

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confidence: 99%

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Direct Anterior Approach in Hip Hemiarthroplasty for Femoral Neck Fractures: Do Short-Term Outcomes Differ with Approach?

et al. 2022

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Background: Hip hemiarthroplasty (HA) is commonly used to treat femoral neck fractures, but it remains unclear if the surgical approach impacts patient outcomes for this commonly performed procedure. The objective of this systematic review and meta-analysis was to assess early postoperative outcomes in patients undergoing HA for femoral neck fracture with the direct anterior approach (DAA) compared with other approaches. Methods:The Cochrane Central Registry of Controlled Trials, MEDLINE, and Google Scholar databases were searched for randomized controlled trials, prospective nonrandomized trials, and retrospective studies published prior to September 7, 2021, comparing DAA with other approaches (anterolateral approach [ALA], direct lateral approach [DLA], and posterior-based approach [PA]) in HA for femoral neck fractures. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcomes included functional outcomes, total complications, prosthetic dislocation, periprosthetic fracture, periprosthetic joint infection (PJI), reoperation, mortality, pain, operative time, and perioperative blood loss. Fixed effect odds ratios, along with their 95% confidence intervals, were used to analyze dichotomous variables. Significance was set at p , 0.05. Meta-analysis was conducted with Review Manager 5.4. Results:In total, 19 studies were included for qualitative analysis and 16 studies were included for quantitative analysis, with a total of 1,604 cases analyzed (723 DAA, 215 ALA, 301 DLA, and 365 PA). Compared with other approaches, the use of the DAA for HA was associated with improved early postoperative functional outcomes, lower early postoperative pain scores, fewer total complications, and fewer prosthetic hip dislocations. The rates of periprosthetic fracture, PJI, and reoperation, pain scores beyond 40 days, operative time, perioperative blood loss, and mortality were not significantly different between surgical approaches.Conclusions: Utilizing the DAA while performing HA for femoral neck fractures is associated with improved functional outcomes, lower early postoperative pain scores, lower incidence of prosthetic hip dislocation, and potentially fewer total complications. Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A855).

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Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

Direct Anterior Approach in Hip Hemiarthroplasty for Femoral Neck Fractures: Do Short-Term Outcomes Differ with Approach?

et al. 2022

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“…A ceiling effect was observed in our cohort, and it was in accordance with the strong ceiling effect described by the original authors. Nevertheless, in the short term (3-6 months) following TKA and THA surgeries, improvements tend to be extremely positive [33,34], especially when performed in high-volume specialized centers such as the one where this study was conducted [35], and therefore, such an effect on satisfaction was expected.…”

Section: Discussionmentioning

confidence: 96%

Italian Translation, Adaptation, and Validation of the Novel Satisfaction Measure Assessment after Primary Total Joint Arthroplasty: The Goodman Score Questionnaire

et al. 2022

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Patient satisfaction after total joint arthroplasties (TJA) represents a key element for the evaluation of surgery success in relation to subjects’ needs and expectations. The assessment tools are applied inconsistently throughout the literature, and thus, it is difficult to compare results among different studies. Goodman et al. proposed a standardized questionnaire with strong psychometric properties for the assessment of satisfaction. The present study aims to translate, adapt, and validate the Goodman questionnaire for the Italian population. After translation and back translation, the questionnaire was administrated to 50 patients. Internal consistency, test–retest reliability, floor and ceiling effects, and construct validity were evaluated (correlation with KOOS/HOOS, SF-12 PCS/MCS, EQ-5D). Responsiveness was evaluated with respect to SF-12 PCS improvements. The Italian version of the Goodman score questionnaire demonstrated psychometric properties similar to those of the original version. The translated questionnaire showed good internal consistency (Cronbach’s alpha = 0.836) and test–retest reliability (ICC: 0.507). Moderate/strong correlations were observed between the Italian version of the Goodman score and other scores. The score significantly discriminated patients who improved from those who did not improve in SF-12 PCS after treatment. This study provides an adapted and validated Italian version of the Goodman score questionnaire, with psychometric properties similar to those of its original counterpart.

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“…4 There are different surgical approaches for THA, without a particular predisposition given the current literature. 5,6 Although the posterolateral approach is still the most frequently used approach, the direct anterior approach (DAA) is gaining popularity. 7 In the DAA, the hip joint is replaced with reduced soft tissue trauma, theoretically reducing the risk of dislocation.…”

Section: Introductionmentioning

confidence: 99%

How do dislocation rates differ between different approaches to total hip arthroplasty? A systematic review and meta-analysis

Koster

Luzier

Temmerman

et al. 2023

Journal of Orthopaedics, Trauma and Rehabilitation

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Background: Different surgical approaches for total hip arthroplasty (THA) exist, without predisposition when it comes to dislocation risk. The direct anterior approach (DAA) is thought to have reduced risk since soft tissue trauma is minimalized. Therefore, we assessed the dislocation risk for different surgical approaches, and the relative dislocation risk of DAA compared to other approaches. Methods: Six electronic databases were systematically searched for prospective studies reporting dislocation following THA. Proportion meta-analyses were performed to assess the dislocation rate for subgroups of the surgical approach. Meta-analysis for binary outcomes was performed to determine the relative risk of dislocation for the DAA compared to other approaches. Results: Eleven studies with 2025 patients were included (mean age 64.6 years, 44% male, mean follow-up 10.5 months), of which four studies were also used in the risk ratio meta-analysis. Overall dislocation rate was 0.79% (95% CI 0.37–1.69). Subgroup analyses showed that most dislocations occurred in the posterior approaches group (1.38%), however non-significant. Furthermore, the DAA emerged with a non-significant lower risk of dislocation (RR 0.37, 95% CI 0.05–2.46) compared to other surgical approaches. Conclusion: Current literature shows non-significant predisposition for a surgical approach to THA regarding dislocation risk. To what extent patient characteristics influence the risk of dislocation could not be determined. Future research should focus on this, as well as on the influence of a surgeon's experience with a specific approach.

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Short-term outcomes vary by surgical approach in total hip arthroplasty: a network meta-analysis

Cited by 24 publications

References 44 publications

Direct Anterior Approach in Hip Hemiarthroplasty for Femoral Neck Fractures: Do Short-Term Outcomes Differ with Approach?

Direct Anterior Approach in Hip Hemiarthroplasty for Femoral Neck Fractures: Do Short-Term Outcomes Differ with Approach?

Italian Translation, Adaptation, and Validation of the Novel Satisfaction Measure Assessment after Primary Total Joint Arthroplasty: The Goodman Score Questionnaire

How do dislocation rates differ between different approaches to total hip arthroplasty? A systematic review and meta-analysis

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