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

Zhou, Zhongsheng; Li, Yang; Yi, Peng; Jiang, Jinlan; Zuo, Jianlin

doi:10.3389/fsurg.2022.1022937

Cited by 19 publications

(8 citation statements)

References 46 publications

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“…For the first part, 28 MAs[ 6 , 20 - 46 ] were identified from PubMed and Scopus according to PICOS, including 61 RCTs. Finally, 40 RCTs were retrieved from previous MAs after screening for the eligible criteria and removing duplicated studies.…”

Section: Resultsmentioning

confidence: 99%

“…Many systematic reviews and meta-analysis (MA) of THA[ 6 , 20 - 46 ] showed that DAA could be beneficial for early hip function, and post-operative pain than other techniques[ 6 , 23 , 28 , 30 , 34 - 36 , 42 , 44 , 45 ]. Contradictory, it came up with a higher incidence of nerve injury[ 28 , 32 , 42 , 45 , 47 ], and inconsistent issues of other complications[ 6 , 31 , 37 , 39 , 44 ].…”

Section: Introductionmentioning

confidence: 99%

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Which approach of total hip arthroplasty is the best efficacy and least complication?

Nitiwarangkul,

Hongku,

Pattanaprateep

et al. 2024

World J Orthop

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BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function. Approaches of the hip have been exhaustively explored about pros and cons. The efficacy and the complications of hip approaches remains inconclusive. This study conducted an umbrella review to systematically appraise previous meta-analysis (MAs) including conventional posterior approach (PA), and minimally invasive surgeries as the lateral approach (LA), direct anterior approach (DAA), 2-incisions method, mini-lateral approach and the newest technique direct superior approach (DSA) or supercapsular percutaneously-assisted total hip (SuperPath). AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials (RCTs). METHODS MAs were identified from MEDLINE and Scopus from inception until 2023. RCTs were then updated from the latest MA to September 2023. This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score (HHS), dislocation, intra-operative fracture, wound complication, nerve injury, operative time, operative blood loss, length of hospital stay, incision length and VAS pain. Data were independently selected, extracted and assessed by two reviewers. Network MA and cluster rank and surface under the cumulative ranking curve (SUCRA) were estimated for treatment efficacy and safety. RESULTS Finally, twenty-eight MAs (40 RCTs), and 13 RCTs were retrieved. In total 47 RCTs were included for reanalysis. The results of corrected covered area showed high degree (13.80%). Among 47 RCTs, most of the studies were low risk of bias in part of random process and outcome reporting, while other domains were medium to high risk of bias. DAA significantly provided higher HHS at three months than PA [pooled unstandardized mean difference (USMD): 3.49, 95% confidence interval (CI): 0.98, 6.00 with SUCRA: 85.9], followed by DSA/SuperPath (USMD: 1.57, 95%CI: -1.55, 4.69 with SUCRA: 57.6). All approaches had indifferent dislocation and intraoperative fracture rates. SUCRA comparing early functional outcome and composite complications (dislocation, intra-operative fracture, wound complication, and nerve injury) found DAA was the best approach followed by DSA/SuperPath. CONCLUSION DSA/SuperPath had better earlier functional outcome than PA, but still could not overcome the result of DAA. This technique might be the other preferred option with acceptable complications.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Which approach of total hip arthroplasty is the best efficacy and least complication?

Nitiwarangkul,

Hongku,

Pattanaprateep

et al. 2024

World J Orthop

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“…The present study showed a slightly lower dislocation rate in the group of patients operated via DAA. However, studies with larger numbers of patients could no longer detect a significant difference [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Postoperative lymphedema after primary total hip arthroplasty: prospective analysis of bikini incision-type direct anterior approach versus established standard approaches

Banasiak,

Hartel,

Frosch

et al. 2024

J Orthop Surg Res

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Background Minimally invasive approaches to the hip joint for total hip arthroplasty such as the DAA (“Direct Anterior Approach with bikini incision”) are increasingly utilized. According to the literature, this approach is more muscle-sparing, results in less postoperative pain, and achieves higher patient satisfaction. The existence of postoperative lymphedema after hip arthroplasty is hardly considered. The aim of this paper is to contribute to the evaluation of the different access methods related to postoperative lymphedema and their functional outcomes. Methods This is a prospective non-randomized study at an orthopedic specialist clinic in Northern Europe. The surgeons that performed the arthroplasties are high-volume surgeons in private practice affiliated to the clinic. The study included 188 patients with primary hip arthroplasty in a 1:1 ratio (DAA: standard accesses (posterior, transgluteal, and anterolateral access)). Epidemiologic data, Harris Hip Score, Oxford Hip Score, European Quality of Life 5, and Visual Analog Scale were collected preoperatively on admission day, 3rd and 5th postoperative day, and follow-up after 1 year. Furthermore, the range of motion, gait, and ability to climb stairs, as well as the presence of hypesthesia were assessed. To evaluate the edema situation, both legs were measured on the 3rd and 5th postoperative day. The prescription of manual lymphatic drainage and remaining swelling conditions 1 year postoperatively were recorded. Results For each group, 94 patients with a mean age of 61.7 years (DAA 60.7 and standard access 62.6) were included. All but one patient in the DAA group showed postoperative lymphedema (n: 93/94; 98.9%). In the standard surgery group, only n: 37/94 (39.4%) showed swelling symptoms requiring treatment. After 1 year, lymphedema persisted in 20 patients in the DAA group and 0 patients in the standard-OR group. Hypesthesia at the ventral thigh persisted in 16/94 (= 17%) patients of the DAA group versus 0/94 patients of the standard group after 12 months. Of these 16 cases, 10 had concomitant edema (62.5%). The DAA showed better results than the standard accesses in terms of Oxford Hip Score (p < 0.05) and ability to climb stairs (p < 0.05). In contrast, the Visual Analog Scale and patient quality of life results showed no significant difference (p > 0.05). Conclusion The present study demonstrated the increased incidence of postoperative lymphedema in patients operated on via DAA access using a Bikini-type skin incision. In the follow-up, significantly more hypesthesia of the ventral thigh occurred in the DAA group. Otherwise, the DAA proved to be superior to the standard approaches from a functional point of view at short-term follow-up. Future research is needed to compare the horizontally oblique to the longitudinal oblique skin incision technique in direct anterior hip surgery regarding the above-mentioned adverse effects found in this study.

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“…However, no functional difference between the 2 groups were noticed when looking at 6-month Harris hip scores [ 35 ]. While the literature indicates different surgical approaches have variable muscle damage, most studies reveal equal outcomes around 6 weeks postoperatively and further research is warranted in this field [ 36 ].…”

Section: Approaches In Total Hip Arthroplastymentioning

confidence: 99%

Surgical Approaches in Total Hip Arthroplasty

Supra¹,

Supra²,

Agrawal³

2023

J Ortho Sports Med

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The Total Hip Arthroplasty (THA) has become one of the most reliable surgical interventions that has improved the quality of life in many patients. THA allows patients to have increased mobility, range of motion, and reduced pain in patients with degenerative hip joints. This surgical procedure has become an effective treatment option for several chronic conditions affecting the hip joint. Although this surgery has been shown to give promising results in patients with hip pathology, selecting the approach for THA is a critical step in pre-operative planning. The best approach for this surgical procedure depends on multiple factors and each present with their own challenges, success rates, and limitations. To further elucidate the advantages and disadvantages associated with different surgical approaches, we critically review each surgical approach along with the different causes of failure of the THA procedure.

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

Cited by 19 publications

References 46 publications

Which approach of total hip arthroplasty is the best efficacy and least complication?

Which approach of total hip arthroplasty is the best efficacy and least complication?

Postoperative lymphedema after primary total hip arthroplasty: prospective analysis of bikini incision-type direct anterior approach versus established standard approaches

Surgical Approaches in Total Hip Arthroplasty

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