A meta-analysis on RCTs of direct anterior and conventional approaches in total hip arthroplasty

Abstract

To conduct a systematic review and meta-analyses on short-term outcomes between total hip arthroplasty (THA) through direct anterior approach (DAA) compared to THA through conventional approaches (CAs) in treatment of hip diseases and fractures. We performed a systematic literature search up to March 1, 2021 to identify RCTs, comparing THA through DAA with THA through CAs. We calculated mean differences (MDs) with 95% confidence intervals (CIs) for continuous outcomes, using the DerSimonian and Laird method and a random effects model. We calculated odds ratios (ORs) with 95% CIs for dichotomous outcomes, using the Mantel–Haenszel method and a random effects model. Ten RCTs met the criteria for final meta-analysis, involving 1053 patients. Four studies were blinded RCTs with a level I evidence, the other 6 studies were non-blinded RCTs with a level II evidence. DAA had a longer operation time than CAs (MD = 17.8, 95% CI 4.8 to 30.8); DAA had similar results compared to CAs for incision length (MD = − 1.1, 95% CI − 4.1 to 1.8), for intraoperative blood loss (MD = 67.2, 95% CI − 34.8 to 169.1), for HHS 3 months postoperatively (MD = 2.4, 95% CI − 0.7 to 5.5), for HHS 6 months postoperatively (MD = 0.8, 95% CI − 1.9 to 3.5), for HHS 12 months postoperatively (MD = 0.9, 95% CI − 0.7 to 2.5), for pain VAS 1 day postoperatively (MD = − 0.9, 95% CI − 2.0 to 0.15), for acetabular cup anteversion angle (MD = − 4.3, 95% CI − 5.2 to − 3.5), for acetabular cup inclination angle (MD = − 0.5, 95% CI − 2.1 to 1.1) and for postoperative complications (OR = 2.4, 95% CI 0.5 to 12.4). Considering the overall results of our meta-analysis, we can conclude that THA through DAA showed similar short-term surgical, functional, radiological outcomes and postoperative complications compared to THA through CAs.

Clinical efficacy of direct anterior approach vs. other surgical approaches for total hip arthroplasty: A systematic review and meta-analysis based on RCTs

“…Furthermore, they did not include three recent high-quality RCTs. The Ramadanov et al ( 36 ) study, published in 2021, included 10 RCTs. Their study, like Wang et al's ( 33 ) study, did not comprehensively incorporate all published RCTs.…”

“…Their study, like Wang et al's ( 33 ) study, did not comprehensively incorporate all published RCTs. Furthermore, the Ramadanov et al ( 36 ) study included THA resulting from fractures, which inevitably introduced bias. In conclusion, our study comprehensively included published RCT studies, all of which were hip replacements caused by hip non-fracture factors.…”

Direct Anterior versus Lateral Approach for Femoral Neck Fracture: Role in COVID-19 Disease

“…Nevertheless, as shown by Moskal et al [ 44 ], the complication rate is related to the learning curve [ 45 ]. In a meta-analysis conducted by Ramadanov et al [ 16 ], the operation time of THA through the conventional lateral approaches was 17.8 min. shorter than the operation time of THA through DAA.…”

“…The physiologic rationale for the lateral decubitus in non-intubated patients is strong, especially because, during the procedure, the patients are still able to continue or start a trial of NIV or HFNC, with no interruption in therapy and no need for intubation to control the upcoming worsening of breathing patterns (such as the increased work of breathing or dangerous minute ventilation). This can further deteriorate the acute respiratory failure or the requirement for prolonged invasive mechanical ventilation for several days, due to the deleterious effect of lying supine, with the injurious effect of a strong respiratory effort that can lead to excessive diaphragm activity with no limits on the tidal stress and strain imposed on the lungs and the onset of “patient self-inflicted lung injury” (P-SILI) [ 16 , 63 ].…”

“…The direct lateral hip approach, according to Hardinge, involved the dissection of the fibers of the gluteus medius and vastus laterals to reach the joint. The recent findings are contradictory and the authors are not able to underline any superiority between the two procedures [ 16 , 17 ].…”