Risk Factors and Predictors for Functional Outcome and Complication Rate in Total Hip Arthroplasty through Minimally Invasive and Conventional Approaches: A Systematic Review and Meta-Regression Analysis of 41 Randomized Controlled Trials

Abstract

Objective: To investigate and identify risk factors and predictors for the difference in functional outcome and complications between total hip arthroplasty (THA) through minimally invasive and conventional approaches, using a meta-regression analysis of randomized controlled trials (RCTs). Methods: A systematic review of the literature up to 31 July 2022 was performed. A meta-regression was conducted based on a random effects meta-analysis using the Hartung–Knapp–Sidik–Jonkman method. Results: A total of 41 RCTs with 3607 patients were found. The following predictors of HHS ≥ 6 months postoperatively were identified: patient age (predictor estimate = 0.14; p < 0.01), avascular necrosis of the femoral head (predictor estimate = −0.03; p = 0.04); incision length (predictor estimate = −0.82; p < 0.01). The following predictors of complication rate were identified: osteoarthritis (predictor estimate = 0.02; p = 0.02); femoral neck fracture (predictor estimate = −0.02; p = 0.02); SuperPATH (predictor estimate = −1.72; p < 0.01). Conclusions: Patient age, avascular necrosis of the femoral head, and incision length were identified as predictors of the effect size of the HHS ≥ 6 months postoperatively; and osteoarthritis, femoral neck fracture, and SuperPATH as predictors of the effect size of the complication rate. Based on these findings, we recommend that more frequent use of minimally invasive THA in elderly patients should be considered. Level of evidence I: a systematic review of all relevant randomized controlled trials. Registered in PROSPERO on 10 August 2022 (CRD42022350287).

Patient‐related Predictors for the Functional Outcome of SuperPATH Hemiarthroplasty versus Conventional Approach Hemiarthroplasty: A Systematic Review and Meta‐regression Analysis of Randomized Controlled Trials

“…In our patient cohort, the mean incision length for SuperPATH HA was 6.89 cm, ranging from 6.90 to 7.82 cm, and the mean incision length for CA HA was 11.19 cm, ranging from 9.08 to 17.1 cm. This finding is consistent with the recent metaregression analysis 13 investigating predictors of outcome for minimally invasive THA and CA THA. There, the effect size of HHS ≥6 months postoperatively decreased by an average of 0.82 points for each 1 cm increase in mean incision length.…”

“…Elderly patients appear to benefit more from SuperPATH HA than from CA HA compared with younger patients. This finding is consistent with the results of a recent meta-regression analysis 13 investigating predictors of minimally invasive THA outcome and CA THA outcome. This study 13 also found a strong positive association between patient age and the effect size of HHS ≤3 months postoperatively.…”

“…This finding is consistent with the results of a recent meta-regression analysis 13 investigating predictors of minimally invasive THA outcome and CA THA outcome. This study 13 also found a strong positive association between patient age and the effect size of HHS ≤3 months postoperatively. A reasonable explanation for the similar findings is certainly the obvious fact that younger patients are better able to compensate for tissue trauma than elderly patients.…”

“…There, the effect size of HHS ≥6 months postoperatively decreased by an average of 0.82 points for each 1 cm increase in mean incision length. 13 Furthermore, a positive association between intraoperative blood loss and the effect size of HHS 3 months postoperatively was found. The effect size of HHS 3 months postoperatively increased by an average of 0.02 points for each 1 mL increase in mean intraoperative blood loss.…”

“… 12 A recent meta‐regression analysis of 41 RCTs with 3607 patients showed that elderly THA patients in particular benefit from minimally invasive surgery. 13 However, the application of minimally invasive surgery in patients with femoral neck fracture still appears to be underused. The persisting skepticism of traumatologists towards minimally invasive orthopedic techniques and the lower outcome demand of acute traumatological patients than elective orthopedic patients might be regarded as a possible explanation.…”