Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review

Abstract

Background: The direct anterior approach (DAA) for total hip arthroplasty (THA) was originally performed with a supine patient on a specialised traction table, but the approach can also be performed on a standard operating table. Despite cost and safety implications, there are few studies directly comparing these techniques and table choice remains largely surgeon preference. The purpose of this review was to compare the clinical outcomes and complication profiles of traction and standard table DAA for primary THA. Methods: The authors searched databases for relevant studies, screening in duplicate. Study quality was assessed using MINORS criteria or Cochrane Risk of Bias Tool. Data pertaining to patient demographics, clinical outcomes, and complications were abstracted. Results: Of 3085 initial titles, 44 studies containing a total 26,353 patients were included and analysed. Mean operative time was 70.9 ± 21.2 minutes for standard table ( n = 4402) and 100.1 ± 32.6 minutes for traction table ( n = 3518). Mean estimated blood loss was 382.3 ± 246.4 mL for standard ( n = 2992) and 531.7 ± 364.3 mL for traction table ( n = 2675). Intra-operative fracture rate was 1.3% for standard table ( n = 3940) and 1.7% for traction table ( n = 8386). Complication rates including revisions, dislocations and peri-prosthetic fractures were qualitatively similar between traction and standard table studies. Conclusion: Standard table and traction table DAA have similar outcomes and complications. Both techniques offer the short-term advantages of DAA when compared to other THA approaches. However, the standard table technique may offer perioperative advantages including decreased blood loss, shorter operative time, and fewer intraoperative fractures. In the context of rising global healthcare costs and lack of access to specialised orthopaedic traction tables, this review at minimum confirms the short-term safety of standard table DAA THA and prompts the need for future studies to directly compare these techniques.

Repair of Symptomatic Partial Gluteus Medius Tear During Total Hip Arthroplasty Through the Direct Anterior Approach

“…The authors acknowledge the demanding nature of this procedure, especially at the beginning of the DAA learning curve (Tables 3 and 4). [15][16][17] Moreover, although the use of a traction table is not mandatory for primary DAA THA, 18 the contemporary surgical technique has been implemented by the authors while using an specialized traction table.…”

Direct Anterior Versus Anterolateral and Posterolateral Approaches to Total Hip Replacement: Comparative Accuracy of Acetabular Implant Placement and Early Clinical Outcomes

“…We assessed DAA-THA using both a speci c orthopedic table and standard operation table . A systematic review conducted by Sarraj et al [23] that collected 44 studies concluded that speci c orthopedic tables and standard operation tables present similar outcomes and complications. However, intraoperative blood loss, surgical time, and intra-operative fracture rate were greater in the speci c orthopedic table group than in the standard operation table group [23].…”

Direct Anterior Approach for Total Hip Arthroplasty in the Lateral Decubitus Position Versus Supine Position: A Random Clinical Trial

“…Sarraj et al compared DAA with use of a traction bed and a standard operating bed, and concluded that the standard operating bed and traction bed had similar clinical outcomes and complication rates. Using the standard operating bed had more advantages, including reduced blood loss, shorter operating time, and fewer intraoperative fractures rates [19]. Meanwhile, it also has disadvantages such as the need for more assistants, the di culty in the femur exposing, and the possibility of additional soft tissue injury.…”