Comparison of direct anterior, lateral, posterior and posterior-2 approaches in total hip arthroplasty: network meta-analysis

Putananon, Chinundorn; Tuchinda, Harit; Arirachakaran, Alisara; Wongsak, Siwadol; Narinsorasak, Thana; Kongtharvonskul, Jatupon

doi:10.1007/s00590-017-2046-1

Cited by 86 publications

(92 citation statements)

References 50 publications

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“…Good maintenance of muscular structures during Watson‐Jones surgery and along minimally invasive pathways allows better functional recovery and good post‐operative proprioception 33,34 …”

Section: Discussionmentioning

confidence: 99%

Fascia and soft tissues innervation in the human hip and their possible role in post‐surgical pain

Fede

Porzionato

Petrelli

et al. 2020

Journal Orthopaedic Research

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Persistent symptoms, most commonly pain, may remain after otherwise successful hip replacement surgery. Innervation of fascia and soft tissues has become increasingly important in etiopathogenesis of pain, but the relative importance of the various anatomical structures in the hip region is still not known. Innervation of skin, superficial adipose tissue, superficial fascia, deep adipose tissue, deep fascia, muscles, capsule, capsule ligament, ligamentum teres, and tendon in the human hip from 11 patients and 2 cadavers were quantified by staining with anti‐S100 antibody for myelin‐forming Schwann cells, to obtain the percentage of antibody positivity, density and mean diameter of the nerve fibers. The skin was the most highly innervated (0.73% ± 0.37% of positive area in patients; 0.80% ± 0.28% in cadavers); the tendon was the least innervated (0.07% ± 0.01% in patients, 0.07% ± 0.007% in cadavers). The muscles (vasto‐lateral and gluteus medius) were the second most innervated structure according the percentage (0.31% ± 0.13% in living humans, 0.30% ± 0.07% in cadavers), but with only a few nerves, with large diameters (mean diameter 36.4 ± 13.4 µm). Instead, the superficial fasciae showed 0.22% ± 0.06% and 0.26% ± 0.05% of positive areas in living humans and cadavers, respectively. Fasciae were invaded by networks of small nerve fibers, revealing a possible role in pain. The superficial fascia was the second most highly innervated tissue after the skin, with a density of 33.0 ± 2.5/cm2, and a mean nerve sizes of 19.1 ± 7.2 µm. Lastly, the capsule turned out to be poorly innervated (0.09%), showing that its removal does not necessarily lead to painful consequences. Statement of clinical significance: Deeper knowledge about the innervation of the soft tissue in the human hip joint will enhance study and understanding of the best surgical procedures to follow during hip arthroplasty to reduce post‐operative pain.

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Section: Discussionmentioning

confidence: 99%

Fascia and soft tissues innervation in the human hip and their possible role in post‐surgical pain

Fede

Porzionato

Petrelli

et al. 2020

Journal Orthopaedic Research

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“…We found statistically significant differences between DAA and PA with regards to Harris hip score at 2 weeks and 4 weeks post op. Putananon et al [ 26 ] performed a network meta-analysis that compares DAA, lateral, PA, and posterior approaches in THA. Those results showed that DAA for THA gave the best postoperative VAS and Harris hip score.…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis of direct anterior approach versus posterior approach in total hip arthroplasty

et al. 2018

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BackgroundThis meta-analysis aimed to evaluate the postoperative clinical outcomes and safety of the direct anterior approach (DAA) versus posterior approach (PA) in total hip arthroplasty (THA).MethodsWe searched PubMed, Embase, Web of Science, the Cochrane Library, and Google databases from inception to June 2018 to select studies that compared the DAA and PA for THA. Only randomized controlled trials (RCTs) were included. Outcomes included Harris hip score at 2 weeks, 6 weeks, 12 weeks, and 1 year; VAS at 24 h, 48 h, and 72 h; incision length, operation time, postoperative blood loss, length of hospital stay, and complications (intraoperative fracture, postoperative dislocation, heterotopic ossification (HO), and groin pain).ResultsNine RCTs totaling 754 THAs (DAA group = 377, PA group = 377) met the criteria to be included in this meta-analysis. The present meta-analysis indicated that, compared with PA group, DAA group was associated with an increase of the Harris hip score at the 2-week and 4-week time points. No significant difference was found between DAA and PA groups of the Harris hip scores at 12 weeks, 1 year length of hospital stay (p > 0.05). DAA group was associated with a reduction of the VAS at 24 h, 48 h, and 72 h with statistical significance (p < 0.05). What is more, DAA was associated with a reduction of the incision length and postoperative blood loss (p < 0.05). There was no significant difference between the operation time and complications (intraoperative fracture, postoperative dislocation, HO, and groin pain).ConclusionIn THA patients, compared with PA, DAA was associated with an early functional recovery and less pain scores. What is more, DAA was associated with shorter incision length and blood loss.

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“…The PRISMA meta-analysis comparing direct anterior and lateral approaches similarly suggested that DAA may be associated with improved early postoperative functional rehabilitation, lower levels of perceived pain, and shorter hospitalization time [ 15 ]. A recent network meta-analysis by Putananon et al evaluated all surgical approaches for THA [ 6 ]. They suggest that a failure of fixation, instability, and damage to soft tissues, associated with the trauma of the surgical procedure are some of the reasons for post-operative pain, which prevent patients to return to full function and activity.…”

Section: Discussionmentioning

confidence: 99%

“…Two recent systematic reviews and network meta-analysis aimed to evaluate the effectiveness of surgical approach for THA (posterior, posterior-2, anterolateral, direct lateral, and anterior). Outcome measures were the length of the incision, blood loss, operating time, length of stay, complications, gait analysis and post-operative clinical symptoms [ 6 , 7 ]. However, both reviews did not compare the acetabular cup positioning and postoperative leg length discrepancy.…”

Section: Introductionmentioning

confidence: 99%

Acetabular cup orientation and postoperative leg length discrepancy in patients undergoing elective total hip arthroplasty via a direct anterior and anterolateral approaches

Debi

Slamowicz

Cohen

et al. 2018

BMC Musculoskelet Disord

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BackgroundTotal hip arthroplasty (THA) is considered a successful surgical procedure. It can be performed by several surgical approaches. Although the posterior and anterolateral approaches are the most common, there has been increased interest in the direct anterior approach. The goal of the present study is to compare postoperative leg length discrepancy and acetabular cup orientation among patients who underwent total hip arthroplasty through a direct anterior (DAA) and anterolateral (ALA) approaches.MethodsThe study included 172 patients undergoing an elective THA by a single surgeon at our institution within the study period. Ninety-eight arthroplasties were performed through the ALA and 74 arthroplasties through the DAA. Preoperative planning was performed for all patients. Assessment of the two groups included the following postoperative parameters: abduction angle, cup anteversion angle and leg length discrepancy (LLD). Additional analysis was done to evaluate component positioning by comparing deviation from the Lewinnek zone of safety in both approaches.ResultsFor the DAA the absolute LLD was 11 mm, ranging from -6 mm to 5 mm. For the ALA, the absolute LLD was 36 mm, ranging from -22 mm to 14 mm. None of the DAA patients had an absolute LLD greater than 6 mm. Comparatively, 7.4% of the ALA group exceeded 6 mm of LLD in addition to 2.1% with LLD greater than 10 mm. 15% of the ALA group resided out of the Lewinnek abduction zone compared to 3% of the DAA group (P = 0.016). 17% of the ALA group were out of the Lewinnek anteversion zone as opposed to 8% of the DAA group (P = 0.094).ConclusionOur study demonstrates good component positioning outcomes and LLD values in patients following THA through the DAA compared to the ALA.

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Comparison of direct anterior, lateral, posterior and posterior-2 approaches in total hip arthroplasty: network meta-analysis

Cited by 86 publications

References 50 publications

Fascia and soft tissues innervation in the human hip and their possible role in post‐surgical pain

Fascia and soft tissues innervation in the human hip and their possible role in post‐surgical pain

A systematic review and meta-analysis of direct anterior approach versus posterior approach in total hip arthroplasty

Acetabular cup orientation and postoperative leg length discrepancy in patients undergoing elective total hip arthroplasty via a direct anterior and anterolateral approaches

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