Direct anterior approach for total hip arthroplasty with patients in the lateral decubitus versus supine positions: A prospective, double-blinded, randomized clinical trial

Xiao, Yao; Li, Zhanglai; Feng, Eryou; Lin, Feitai; Zhang, Yiyuan; Weng, Yan; Chen, Jinhua

doi:10.1177/23094990221074758

Cited by 2 publications

(2 citation statements)

References 24 publications

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“…In recent years, DAA has become increasingly popular because it causes less muscle damage, has a faster recovery, and is less prone to hip dislocation [35,36]. DAA includes both L-DAA and S-DAA, and few studies have used DAA to directly compare total hip arthroplasty in these two different positions.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, when the patient is in the supine position, the pelvic orientation changes less during the operation. The use of fluoroscopy helps to simulate the pelvic tilt before the operation, and provides feedback on the pelvic orientation and the position of the cup, which improves the accuracy of the surgeon in placing the acetabular component in the safe zone [36]. However, Maeda et al also pointed out that there was no significant difference in cup angle accuracy between DAA in the lateral decubitus position and DAA in the supine group after the use of a mechanical guide [40].…”

Section: Discussionmentioning

confidence: 99%

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Fluoroscopy-guided direct anterior approach total hip arthroplasty provides more accurate component positions in the supine position than in the lateral position

Chen,

Liu,

et al. 2023

BMC Musculoskelet Disord

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Purpose The position of the acetabular and femoral components is critical for stability and wear resistance. The aim of this study is to investigate whether the fluoroscopy-guided direct anterior approach in the supine position (S-DAA) is more helpful in improving the position of acetabular and femoral components than the fluoroscopy-guided direct anterior approach in the lateral decubitus position (L-DAA). Methods A retrospective analysis of 76 cases of fluoroscopy-guided direct anterior approach total hip arthroplasty (38 cases in the S-DAA and 38 cases in the L-DAA group) was performed in one hospital from 2019 to 2021. The differences in inclination, anteversion, femoral offset (FO), global offset (GO), and leg length discrepancy (LLD) measurements during and after surgery were analyzed. The postoperative femoral offset (FO), global offset (GO), leg length discrepancy (LLD), and preoperative and postoperative Harris hip score were compared between the two groups. Results In the S-DAA group, there were no significant differences in the mean intraoperative inclination angle anteversion angle, FO, GO, and LLD compared to the postoperative values, whereas in the L-DAA group, there were significant differences between the intraoperative and postoperative measurements (P < 0.001, P = 0.009, P＜0.001, P＜0.001 and P = 0.008, respectively). Additionally, there were significant differences in the accuracy of LLD, FO, and GO between the two groups (P < 0.001). Compared with the L-DAA group, the average differences of inclination, anteversion, LLD, FO, and GO during and after operation in the S-DAA group were smaller, and the consistency was higher. There was a significant difference in Harris hip score between the two groups at 1 week after surgery (P = 0.033). There was no significant difference in Harris hip score between 1 month and 3 months after surgery (P = 0.482 and P = 0.797, respectively). Conclusions In the supine group, the direct anterior approach (DAA) provides more accurate positioning of the acetabular and femoral components. However, there was no significant difference in hip joint function and activity between the two groups at follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Fluoroscopy-guided direct anterior approach total hip arthroplasty provides more accurate component positions in the supine position than in the lateral position

Chen,

Liu,

et al. 2023

BMC Musculoskelet Disord

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Indirect comparisons of traction table versus standard table in total hip arthroplasty through direct anterior approach: a systematic review and frequentist network meta-analysis

Ramadanov,

Voss,

Hable

et al. 2024

J Orthop Surg Res

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Background It remains unclear whether the use of an orthopaedic traction table (TT) in direct anterior approach (DAA) total hip arthroplasty (THA) results in better outcomes. The aim of this systematic review and network meta-analysis was to compare the THA outcomes through DAA on a standard operating table and the THA outcomes through DAA on a TT. Methods PubMed, Epistemonikos, and Google Scholar were searched for relevant randomized controlled trials (RCTs) up to 01 January 2024. An indirect comparison in network meta-analysis was performed to assess treatment effects between DAA on a TT and DAA on a standard table, using fixed-effects and random-effects models estimated with frequentist approach and consistency assumption. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were estimated for continuous variables and odds ratios (ORs) with 95% CIs were estimated for binary variables. Results The systematic review of the literature identified 43 RCTs with a total of 2,258 patients. DAA with TT had a 102.3 mL higher intraoperative blood loss and a 0.6 mmol/L lower Hb 3 days postoperatively compared with DAA without TT (SMD = 102.33, 95% CI 47.62 to 157.04; SMD = − 0.60, 95% CI − 1.19 to − 0.00). DAA with TT had a 0.15 lower periprosthetic fracture OR compared with DAA without TT (OR 0.15, 95% CI 0.03 to 0.86). There were no further significant differences in surgical, radiological, functional outcomes and in complication rates. Conclusion Based on our findings and taking into account the limitations, we recommend that particular attention be paid to the risk of periprosthetic fracture in DAA on a standard operating table and blood loss in DAA with TT. Since numerous other surgical, radiological, functional outcome parameters and other complication rates studied showed no significant difference between DAA on a standard operating table and DAA with TT, no recommendation for a change in surgical technique seems justified. Level of evidence Level I evidence, because this is a systematic review and meta-analysis of randomized controlled trials.

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Direct anterior approach for total hip arthroplasty with patients in the lateral decubitus versus supine positions: A prospective, double-blinded, randomized clinical trial

Cited by 2 publications

References 24 publications

Fluoroscopy-guided direct anterior approach total hip arthroplasty provides more accurate component positions in the supine position than in the lateral position

Fluoroscopy-guided direct anterior approach total hip arthroplasty provides more accurate component positions in the supine position than in the lateral position

Indirect comparisons of traction table versus standard table in total hip arthroplasty through direct anterior approach: a systematic review and frequentist network meta-analysis

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