Comparative study of radiological and functional outcomes following a direct anterior approach versus to a posterolateral approach to the hip

Godoy-Monzon, Daniel; Buttaro, Martín; Piccaluga, Francisco; Casteulani, Alberto Cid; Ordas, A.

doi:10.1016/j.recote.2019.07.003

Cited by 3 publications

(7 citation statements)

References 23 publications

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“…Ten studies [21,22,23,25,27,31,32,36,37,40] (including 5670 participants) reported a comparison of operative time between the two approaches, and the results Fig. 8 Forest plot comparing the incision length of DAA and PLA Fig.…”

Section: Operative Timementioning

confidence: 99%

“…Five studies [22,23,25,31,32] (5342 participants) reported a comparison of incision length after two types of surgery. The results obtained can prove that there was no significant difference in incision length after the two surgeries (WMD = −1.52, 95% CI −3.55 to 0.52, P = 0.14, Fig.…”

Section: Incision Lengthmentioning

confidence: 99%

“…Two studies [25,36] (105 participants) reported a comparison of LLD between the two surgeries. Results showed that LLD after DAA surgery was less than PLA surgery (Fig.…”

Section: Lldmentioning

confidence: 99%

“…RCTs and high-quality cohort studies [20][21][22][23][24][25][26][27] were included in our study, and the literatures quality were relatively high. The majority of surgeons in the literature we included passed the learning curve, which made the results more reliable ( Table 3).…”

Section: Innovation Of Our Meta-analysismentioning

confidence: 99%

“…Several more high-quality RCT [20][21][22][23] and non-RCTs [24][25][26][27] have been published without conclusive results. Although these literatures hold many new views, it is necessary to analyze this issue because of their single demonstration, a one-sided focus on clinical results, lack of latest data, and lack of recommendation strength.…”

Section: Introductionmentioning

confidence: 99%

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Direct anterior versus posterolateral approaches for clinical outcomes after total hip arthroplasty: a systematic review and meta-analysis

et al. 2020

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Objective The main objective of our study was to compare the intraoperative and postoperative outcomes of direct anterior approach (DAA) with posterolateral approaches (PLA). Methods We searched Cochrane library, Web of Science, and PubMed for literatures comparing DAA with PLA. On the basis of inclusion and exclusion criteria, relevant literatures were selected. Two members independently screened qualified literatures, evaluated the literature quality, and extracted data information. Results Eighteen randomized controlled trials (RCTs) and non-RCTs totaling 34,873 patients (DAA = 9636, PLA = 25237) were contained in this systematic review and meta-analysis. The results showed that DAA were reduced in terms of length of hospital stay (weighted mean difference (WMD) = −0.43, 95% confidence interval (CI) −0.78 to −0.09, P = 0.01), LLD (WMD = −2.00, 95% CI −2.75 to −1.25, P < 0.00001), PE/DVT (WMD = 0.36, 95% CI 0.15 to 0.85, P = 0.02), dislocation (WMD = 0.42, 95% CI 0.30 to 0.59, P < 0.00001) and visual analog scale (VAS) (WMD = −0.57, 95% CI −0.91 to −0.23, P = 0.0009) compared with PLA; however, DAA compared with the PLA was increasing in terms of operative time (WMD = 14.81, 95% CI 7.18 to 22.44, P = 0.0001), intraoperative blood loss (WMD = 105.13, 95% CI 25.35 to 184.90, P = 0.01), fracture (WMD = 1.46, 95% CI 1.00 to 2.11, P = 0.05), and Harris hip score (HHS) (WMD = 1.19, 95% CI 0.77 to 1.61, P < 0.00001). Conclusions DAA was preferable effectiveness to PLA in early pain relief and functional recovery; however, PLA has a shorter operation time, intraoperative less blood loss and fracture. Trial registration Registration ID, CRD42020151208

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Section: Operative Timementioning

confidence: 99%

Section: Incision Lengthmentioning

confidence: 99%

“…Two studies [25,36] (105 participants) reported a comparison of LLD between the two surgeries. Results showed that LLD after DAA surgery was less than PLA surgery (Fig.…”

Section: Lldmentioning

confidence: 99%

Section: Innovation Of Our Meta-analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Direct anterior versus posterolateral approaches for clinical outcomes after total hip arthroplasty: a systematic review and meta-analysis

et al. 2020

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Fast Track Protocols and Early Rehabilitation after Surgery in Total Hip Arthroplasty: A Narrative Review

Martino

Brunello

Pederiva

et al. 2023

Clinics and Practice

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The Enhanced Recovery After Surgery (ERAS) or Fast Track is defined as a multi-disciplinary, peri- and post-operative approach finalized to reduce surgical stress and simplify post-operative recovery. It has been introduced more than 20 years ago by Khelet to improve outcomes in general surgery. Fast Track is adapted to the patient’s condition and improves traditional rehabilitation methods using evidence-based practices. Fast Track programs have been introduced into total hip arthroplasty (THA) surgery, with a reduction in post-operative length of stay, shorter convalescence, and rapid functional recovery without increased morbidity and mortality. We have divided Fast Track into three cores: pre-, intra-, and post-operative. For the first, we analyzed the standards of patient selection, for the second the anesthesiologic and intraoperative protocols, for the third the possible complications and the appropriate postoperative management. This narrative review aims to present the current status of THA Fast Track surgery research, implementation, and perspectives for further improvements. By implementing the ERAS protocol in the THA setting, an increase in patient satisfaction can be obtained while retaining safety and improving clinical outcomes.

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Anterolateral approach may be superior to posterolateral approach in controlling postoperative lower limb discrepancy in primary total hip arthroplasty: A single-center, retrospective cohort study

Xiong

Liu

et al. 2022

Jt Dis Relat Surg

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Objectives: This study aims to investigate the possible association and comparison between anterolateral approach (ALA) and posterolateral approach (PLA) and postoperative lower limb discrepancy (LLD) in selective total hip arthroplasty (THA). Patients and methods: April 2021 and July 2021, a total of 266 consecutive patients (126 males, 140 females; mean age: 46.7±13.6 years; range, 22 to 60 years) who underwent unilateral primary THA via the ALA or the PLA were retrospectively analyzed. The operations were performed by a single surgical team. All patients were divided into two groups according to the approach: ALA group (n=66) and PLA group (n=200). Relevant data were recorded. Diagnosis including hip osteoarthritis, developmental dysplasia of the hip (DDH), aseptic avascular necrosis (AVN), and inflammatory arthritis were noted. Perioperative follow-up radiographs were evaluated and measured to compare the postoperative LLD and offset. The association between two approaches and postoperative LLD and offset was analyzed using the univariate and multivariate linear regression analysis. Results: The mean follow-up was 20±3.7 (range, 16 to 25) months. Univariate analysis revealed that the postoperative LLD, the postoperative acetabular offset, and hospital costs were lower in the ALA group than the PLA group (p <0.01). However, the offset and length of stay were comparable between the two groups (p>0.05). Multivariate analysis revealed that the PLA (β=4.71; 95% confidence interval [CI]: 1.78 to 7.64), preoperative LLD (β=0.29; 95% CI: 0.21 to 0.37), DDH (β=5.01; 95% CI: 1.47 to 8.55), and AVN (β=3.81; 95% CI: 0.50 to 7.12) were the main contributors to the postoperative LLD. Conclusion: Our study results suggest that the ALA may be superior to the PLA in controlling the postoperative LLD among some of the selective unilateral primary THA patients. Both the ALA and the PLA were comparable in terms of the restoration of offset.

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Comparative study of radiological and functional outcomes following a direct anterior approach versus to a posterolateral approach to the hip

Cited by 3 publications

References 23 publications

Direct anterior versus posterolateral approaches for clinical outcomes after total hip arthroplasty: a systematic review and meta-analysis

Direct anterior versus posterolateral approaches for clinical outcomes after total hip arthroplasty: a systematic review and meta-analysis

Fast Track Protocols and Early Rehabilitation after Surgery in Total Hip Arthroplasty: A Narrative Review

Anterolateral approach may be superior to posterolateral approach in controlling postoperative lower limb discrepancy in primary total hip arthroplasty: A single-center, retrospective cohort study

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