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

Chen, Wang; Sun, Jie; Zhang, Ye; Chen, Xiangyang; Feng, Shuo

doi:10.1186/s13018-020-01747-x

Cited by 32 publications

(39 citation statements)

References 35 publications

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“…The direct anterior approach (DAA) is increasingly preferred by surgeons when patients accept hemiarthroplasty (HTA) or total hip arthroplasty (THA) [ 1 , 2 ]. This preference could be attributed to the reasons that DAA is a minimal soft invasion approach and uncovers the joint capsule through inter-muscular and inter-nervous plane [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Preoperative ultrasound to map the three-dimensional anatomical distribution of the lateral femoral cutaneous nerve in direct anterior approach for total hip arthroplasty

Yao

Wang

et al. 2021

J Orthop Surg Res

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Background The postoperative complaints of hypoesthesia or a burning sensation due to lateral femoral cutaneous nerve (LFCN) injury in patients are not yet solved. The present study aimed to identify the three-dimensional (3D) distribution of LFCN using preoperative ultrasound and evaluate the rate of injury in direct anterior approach for total hip arthroplasty. Methods A total of 59 patients (28 males and 31 females, age 69.0 ± 4.6 years, BMI 24.7 ± 3.0 kg/m2) were randomly allocated to the ultrasound group and 58 patients (28 males and 30 females, age 68.5 ± 4.5 years, BMI 24.8 ± 2.8 kg/m2) were in the control group. Surgeons received the data of 3D distribution of LFCN only in the ultrasound group before surgery with respect to the direction, the depth on the skin, and the length to tensor fasciae latae (TFL). The anatomical characteristics of LFCN in the surgical region were summarized. At 1 and 3 months of post surgery, the rate of LFCN injury and abnormal sensitive area was evaluated in both groups. Results There was a significant consistency in gender, age and BMI of these two groups (P > 0.05). Based on the data from the ultrasound group, over 90% of patients had one or two branches of LFCN. LFCN always courses in the fascia layer, the depth ranged from 6.8 ± 2.6 (3.0–12.0) mm to 11.1 ± 3.4 (4.0–17.0) mm and depended on the thickness of the subcutaneous fat, and length was 3.3 ± 4.6 (− 5.0–10.0) mm at proximal part and − 2.7 ± 4.7 (− 10.0–8.0) at distal end to the medial edge of TFL. Both the rate of LFCN injury and abnormal sensory area in the ultrasound group was significantly lower than those in the control group (3.4% vs. 25.9%, P = 0.001, at 1 month; 3.4% vs. 22.4%, P = 0.005, at 3 months). Conclusions LFCN mostly courses along the medial border of TFL in the fascia layer. The 3D distribution of LFCN using preoperative ultrasound mapping could help the surgeons to evaluate the risk of injury preoperatively and decrease the rate of injury during the operation. However, some branch injuries, especially for the fan type LFCN, could not be avoided.

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Section: Introductionmentioning

confidence: 99%

Preoperative ultrasound to map the three-dimensional anatomical distribution of the lateral femoral cutaneous nerve in direct anterior approach for total hip arthroplasty

Yao

Wang

et al. 2021

J Orthop Surg Res

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“…In the control group, 15 (24.2%) patients described abnormal symptoms in the anterolateral thigh, including numbness (15), dull sensation (15), and tingling or pain (4) in the 1st month follow-up, which was signi cantly higher than that in the ultrasound group. The area of abnormal symptoms of the control group was 133.1 ± 104.9 (49 ~ 375) cm 2 , which was signi cant larger than that of ultrasound guiding group. At 3 months, both the number of patients and the area of abnormal symptoms did not show any obvious change in the ultrasound group.…”

Section: Statisticsmentioning

confidence: 74%

“…The direct anterior approach (DAA) is increasingly preferred by surgeons when patients accept hemiarthroplasty (HTA) or total hip arthroplasty (THA) [1,2]. This preference could be attributed to the reasons that DAA is a minimal soft invasion approach and uncovers the joint capsule through intermuscular and inter-nervous plane [3,4].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Ultrasound to Map the Three-Dimensional Anatomical Distribution of the Lateral Femoral Cutaneous Nerve in Direct Anterior Approach for Total Hip Arthroplasty

Yao

Wang

Zhuang

et al. 2021

Preprint

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Background：The postoperative complaints of hypoaesthesia or a burning sensation due to lateral femoral cutaneous nerve (LFCN) injury in patients is not yet solved. The present study aimed to identify the three-dimensional (3D) distribution of LFCN using preoperative ultrasound and evaluate the rate of injury in direct anterior approach for total hip arthroplasty. Methods： A total of 59 patients were allocated to the ultrasound group and 58 patients were in the control group. Surgeons received the data of 3D distribution of LFCN only in the ultrasound group before surgery with respect to the direction, the depth on the skin, and the length to tensor fasciae latae (TFL). The anatomical characteristics of LFCN in the surgical region were summarized. At 1 and 3 months post-surgery, the rate of LFCN injury and abnormal sensitive area were evaluated in both groups. Results： Based on the data from the ultrasound group, over 90% of patients had one or two branches of LFCN. LFCN always courses in the fascia layer, the depth ranged from 6.8±2.6 (3.0 ~12.0) mm to 11.1±3.4 (4.0 ~17.0) mm and depended on the thickness of the subcutaneous fat, and length was 3.3±4.6 (-5.0 ~10.0) mm at proximal part and -2.7±4.7 (-10.0 ~8.0) at distal end to the medial edge of TFL. Both the rate of LFCN injury and abnormal sensory area in the ultrasound group were significantly lower than those in the control group (3.4% VS 25.9%, P=0.001, χ21=11.893, at 1 month; 3.4% VS 22.4%, P=0.005, χ21=9.471, at 3 months).Conclusions： LFCN mostly courses along the medial border of TFL in the fascia layer. The 3D distribution of LFCN could help the surgeons to evaluate the risk of injury preoperatively and decrease the rate of injury during the operation. However, some branch injuries, especially for the fan type LFCN, could not be avoided.

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“…Traditional THA often adopts the posterolateral approach (PLA) or direct lateral approach. In recent years, along with the idea of Enhanced Recovery After Surgery (ERAS), the direct anterior approach (DAA) has been accepted by orthopedists 2 . DAA can expose the hip joint through the gap between the tensor fasciae latae and sartorius and avoid injuring the extorsion muscle 3 .…”

Section: Introductionmentioning

confidence: 99%

Direct Anterior Approach in Lateral Decubitus Position Versus Supine Position for Unilateral Total Hip Arthroplasty: A Comparative Study

Zhao

Yin

et al. 2021

Orthopaedic Surgery

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Objective To compare the clinical efficacy of the direct anterior approach in lateral decubitus position (L‐DAA) and supine position (S‐DAA) for unilateral total hip arthroplasty. Methods A retrospective study was conducted on 89 patients who underwent primary unilateral total hip arthroplasty in our department between August 2016 and December 2017. There were 46 patients who underwent L‐DAA and 43 patients who underwent S‐DAA. The body mass index (BMI), operation time, blood loss, preoperative Hb, first day and third day postoperative Hb, incision length, hospital stay, preoperative and postoperative Harris score, preoperative and postoperative visual analogue scale (VAS) score, radiological evaluation, intraoperative and postoperative complication, postoperative absolute length difference of lower extremity were recorded and analyzed. P < 0.05 was set as the significant difference. Results All patients were followed up for 8–23 months, with an average of 15.6 months. No significant differences were found in preoperative and postoperative Harris scores, preoperative Hb, incision lengths, radiological evaluations, preoperative and postoperative VAS scores, and hospital stay (P > 0.05). However, significant differences were detected in BMI, blood loss, first day and third day postoperative Hb, and operation time (P < 0.05). There were no postoperative complications in the L‐DAA and S‐DAA groups. During the operation, two cases of proximal femoral fracture occurred in the L‐DAA group, four in the S‐DAA group, and the difference was statistically significant. There were significant differences found in the postoperative absolute length difference of lower extremity between the two groups. Conclusion Compared with the S‐DAA approach, the L‐DAA approach had the advantages of shorter operation time and less blood loss. Compared with S‐DAA, it was easier to expose the proximal femur, and lower BMI was required in L‐DAA. However, it was more difficult to compare the length of both lower extremities in the L‐DAA approach than in the S‐DAA approach.

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

Cited by 32 publications

References 35 publications

Preoperative ultrasound to map the three-dimensional anatomical distribution of the lateral femoral cutaneous nerve in direct anterior approach for total hip arthroplasty

Preoperative ultrasound to map the three-dimensional anatomical distribution of the lateral femoral cutaneous nerve in direct anterior approach for total hip arthroplasty

Preoperative Ultrasound to Map the Three-Dimensional Anatomical Distribution of the Lateral Femoral Cutaneous Nerve in Direct Anterior Approach for Total Hip Arthroplasty

Direct Anterior Approach in Lateral Decubitus Position Versus Supine Position for Unilateral Total Hip Arthroplasty: A Comparative Study

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