Clinical efficacy of direct anterior approach vs. other surgical approaches for total hip arthroplasty: A systematic review and meta-analysis based on RCTs
BackgroundDirect anterior approach (DAA) is an accurate technique for total hip arthroplasty (THA) through the muscle gap. Physicians who apply DAA believe that it accelerates patient recovery and results in lower rates of postoperative dislocation. However, the traditional surgical approach adheren...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-10-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2022.1022937/full |
| _version_ | 1828380630985998336 |
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| author | Zhongsheng Zhou Zhongsheng Zhou Yang Li Yachen Peng Jinlan Jiang Jianlin Zuo |
| author_facet | Zhongsheng Zhou Zhongsheng Zhou Yang Li Yachen Peng Jinlan Jiang Jianlin Zuo |
| author_sort | Zhongsheng Zhou |
| collection | DOAJ |
| description | BackgroundDirect anterior approach (DAA) is an accurate technique for total hip arthroplasty (THA) through the muscle gap. Physicians who apply DAA believe that it accelerates patient recovery and results in lower rates of postoperative dislocation. However, the traditional surgical approach adherents believe that it is shorter and has fewer complications than DAA.MethodsWe use the method of META analysis to organize and analyze the data of the randomized controlled studies (RCT) obtained after our screening. To compare the clinical efficacy of DAA approach and other surgical approaches for THA.ResultsAfter rigorous screening, 15 RCT studies were included in our study, and data were extracted. The study included 1,450 patients from 15 RCTs, with a mean age of 63 years and a distribution of 52–67 years. Six weeks after the operation, the Harris hip score of the DAA approach improved by an average of 4.06 points (95% confidence interval (CI) 2.54 −5.59, P < 0.01, I2 = 45%, which can significantly improve the clinical efficacy of patients. However, the 0.61 points [95% confidence interval (CI) −1.13 −2.34, P > 0.01, I2 = 0%] at 3 months and 1.49 points [95% confidence interval (CI) −1.65 −2.25, P > 0.01, I2 = 0%] at 12 months postoperatively. In terms of dislocation rate, results show that the use of DAAs does not reduce Dislocation Rate with significant statistical heterogeneity among study groups (95% CI 0.18–2.94 P > 0.001, I2 = 0%).ConclusionThe hip function of DAA was superior to posterolateral approach (PLA) and latera approach (LA) in the early days after hip replacement, especially within six weeks. However, at six months or more after surgery, the difference was not significant. The DAA did not show a lower rate of dislocation than other surgical approaches.
Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO |
| first_indexed | 2024-12-10T04:00:25Z |
| format | Article |
| id | doaj.art-d31de7653a284ecebf8d9080040c4af4 |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-12-10T04:00:25Z |
| publishDate | 2022-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-d31de7653a284ecebf8d9080040c4af42022-12-22T02:02:59ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2022-10-01910.3389/fsurg.2022.10229371022937Clinical efficacy of direct anterior approach vs. other surgical approaches for total hip arthroplasty: A systematic review and meta-analysis based on RCTsZhongsheng Zhou0Zhongsheng Zhou1Yang Li2Yachen Peng3Jinlan Jiang4Jianlin Zuo5Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, ChinaScientific Research Center, China-Japan Union Hospital of Jilin University, Changchun, ChinaDepartment of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, ChinaDepartment of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, ChinaScientific Research Center, China-Japan Union Hospital of Jilin University, Changchun, ChinaDepartment of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, ChinaBackgroundDirect anterior approach (DAA) is an accurate technique for total hip arthroplasty (THA) through the muscle gap. Physicians who apply DAA believe that it accelerates patient recovery and results in lower rates of postoperative dislocation. However, the traditional surgical approach adherents believe that it is shorter and has fewer complications than DAA.MethodsWe use the method of META analysis to organize and analyze the data of the randomized controlled studies (RCT) obtained after our screening. To compare the clinical efficacy of DAA approach and other surgical approaches for THA.ResultsAfter rigorous screening, 15 RCT studies were included in our study, and data were extracted. The study included 1,450 patients from 15 RCTs, with a mean age of 63 years and a distribution of 52–67 years. Six weeks after the operation, the Harris hip score of the DAA approach improved by an average of 4.06 points (95% confidence interval (CI) 2.54 −5.59, P < 0.01, I2 = 45%, which can significantly improve the clinical efficacy of patients. However, the 0.61 points [95% confidence interval (CI) −1.13 −2.34, P > 0.01, I2 = 0%] at 3 months and 1.49 points [95% confidence interval (CI) −1.65 −2.25, P > 0.01, I2 = 0%] at 12 months postoperatively. In terms of dislocation rate, results show that the use of DAAs does not reduce Dislocation Rate with significant statistical heterogeneity among study groups (95% CI 0.18–2.94 P > 0.001, I2 = 0%).ConclusionThe hip function of DAA was superior to posterolateral approach (PLA) and latera approach (LA) in the early days after hip replacement, especially within six weeks. However, at six months or more after surgery, the difference was not significant. The DAA did not show a lower rate of dislocation than other surgical approaches. Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPEROhttps://www.frontiersin.org/articles/10.3389/fsurg.2022.1022937/fulltotal hip arthroplastydirect anterior approachrandomized controlled trialmeta-analysisclinical efficacy analysis |
| spellingShingle | Zhongsheng Zhou Zhongsheng Zhou Yang Li Yachen Peng Jinlan Jiang Jianlin Zuo Clinical efficacy of direct anterior approach vs. other surgical approaches for total hip arthroplasty: A systematic review and meta-analysis based on RCTs Frontiers in Surgery total hip arthroplasty direct anterior approach randomized controlled trial meta-analysis clinical efficacy analysis |
| title | Clinical efficacy of direct anterior approach vs. other surgical approaches for total hip arthroplasty: A systematic review and meta-analysis based on RCTs |
| title_full | Clinical efficacy of direct anterior approach vs. other surgical approaches for total hip arthroplasty: A systematic review and meta-analysis based on RCTs |
| title_fullStr | Clinical efficacy of direct anterior approach vs. other surgical approaches for total hip arthroplasty: A systematic review and meta-analysis based on RCTs |
| title_full_unstemmed | Clinical efficacy of direct anterior approach vs. other surgical approaches for total hip arthroplasty: A systematic review and meta-analysis based on RCTs |
| title_short | Clinical efficacy of direct anterior approach vs. other surgical approaches for total hip arthroplasty: A systematic review and meta-analysis based on RCTs |
| title_sort | clinical efficacy of direct anterior approach vs other surgical approaches for total hip arthroplasty a systematic review and meta analysis based on rcts |
| topic | total hip arthroplasty direct anterior approach randomized controlled trial meta-analysis clinical efficacy analysis |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2022.1022937/full |
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