Direct Anterior Approach Versus Posterolateral Approach in Total Hip Arthroplasty: A Systematic Review and Meta‐analysis of Randomized Controlled Studies
Objective To compare the early rehabilitation effects of total hip arthroplasty (THA) with the direct anterior approach (DAA) versus the posterior approach (PA). Methods We searched PubMed, Embase, Web of Science, the Cochrane Library, and Google databases from inception to June 2019 to select studi...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-08-01
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| Series: | Orthopaedic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/os.12669 |
| _version_ | 1818341394408800256 |
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| author | Xian‐teng Yang Hai‐feng Huang Li Sun Zhen Yang Chao‐yong Deng Xiao‐bin Tian |
| author_facet | Xian‐teng Yang Hai‐feng Huang Li Sun Zhen Yang Chao‐yong Deng Xiao‐bin Tian |
| author_sort | Xian‐teng Yang |
| collection | DOAJ |
| description | Objective To compare the early rehabilitation effects of total hip arthroplasty (THA) with the direct anterior approach (DAA) versus the posterior approach (PA). Methods We searched PubMed, Embase, Web of Science, the Cochrane Library, and Google databases from inception to June 2019 to select studies that compared the DAA and PA for THA. Only randomized controlled trials (RCT) were included. Two researchers independently screened studies for inclusion, extracted data, and assessed the methodological quality. A meta‐analysis was conducted using RevMan 5.3 software provided by Cochrane Assisted Network. Results A total of 932 patients underwent THA. There were 467 cases in group DAA and 465 cases in group PA. There was a significant difference in the incidence of lateral femoral cutaneous nerve injury between DAA and PA groups (RR = 38.97, 95% CI: 7.89–192.57, P < 0.05). DAA was associated with less pain compared with PA [WMD = −0.65, 95% CI (−0.91–0.38), P < 0.05]. There was no significant difference in operation time, hospitalization stay, and intraoperative bleeding volume. Moreover, in supplementary data, the number of acetabular prostheses in Lewinnek's safety zones in DAA was more than that in the PA group (RR = 1.20, 95% CI [1.04–1.39], P < 0.05), and the time of discontinuation of walking aids in the DAA group was earlier than that in the PA group (WMD = −11.05, 95% CI [−17.79–4.31], P < 0.05). Conclusion The DAA total hip arthroplasty has comparable results with PA, with earlier postoperative functional recovery, less postoperative pain scores, and higher incidence of lateral femoral cutaneous nerve injury. The results need to be validated by large‐sample, high‐quality RCT studies, and long‐term follow‐up of complications. |
| first_indexed | 2024-12-13T15:58:06Z |
| format | Article |
| id | doaj.art-db8a0608daa742de8f131eacb56e3f72 |
| institution | Directory Open Access Journal |
| issn | 1757-7853 1757-7861 |
| language | English |
| last_indexed | 2024-12-13T15:58:06Z |
| publishDate | 2020-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Orthopaedic Surgery |
| spelling | doaj.art-db8a0608daa742de8f131eacb56e3f722022-12-21T23:39:15ZengWileyOrthopaedic Surgery1757-78531757-78612020-08-011241065107310.1111/os.12669Direct Anterior Approach Versus Posterolateral Approach in Total Hip Arthroplasty: A Systematic Review and Meta‐analysis of Randomized Controlled StudiesXian‐teng Yang0Hai‐feng Huang1Li Sun2Zhen Yang3Chao‐yong Deng4Xiao‐bin Tian5Department of Orthopaedics People’s Hospital of Guizhou Province, Guiyang Guangzhou ChinaDepartment of Orthopaedics People’s Hospital of Guizhou Province, Guiyang Guangzhou ChinaDepartment of Orthopaedics People’s Hospital of Guizhou Province, Guiyang Guangzhou ChinaDepartment of Orthopaedics People’s Hospital of Guizhou Province, Guiyang Guangzhou ChinaMedical College of Guizhou University Guiyang ChinaGuizhou Medical University Guiyang ChinaObjective To compare the early rehabilitation effects of total hip arthroplasty (THA) with the direct anterior approach (DAA) versus the posterior approach (PA). Methods We searched PubMed, Embase, Web of Science, the Cochrane Library, and Google databases from inception to June 2019 to select studies that compared the DAA and PA for THA. Only randomized controlled trials (RCT) were included. Two researchers independently screened studies for inclusion, extracted data, and assessed the methodological quality. A meta‐analysis was conducted using RevMan 5.3 software provided by Cochrane Assisted Network. Results A total of 932 patients underwent THA. There were 467 cases in group DAA and 465 cases in group PA. There was a significant difference in the incidence of lateral femoral cutaneous nerve injury between DAA and PA groups (RR = 38.97, 95% CI: 7.89–192.57, P < 0.05). DAA was associated with less pain compared with PA [WMD = −0.65, 95% CI (−0.91–0.38), P < 0.05]. There was no significant difference in operation time, hospitalization stay, and intraoperative bleeding volume. Moreover, in supplementary data, the number of acetabular prostheses in Lewinnek's safety zones in DAA was more than that in the PA group (RR = 1.20, 95% CI [1.04–1.39], P < 0.05), and the time of discontinuation of walking aids in the DAA group was earlier than that in the PA group (WMD = −11.05, 95% CI [−17.79–4.31], P < 0.05). Conclusion The DAA total hip arthroplasty has comparable results with PA, with earlier postoperative functional recovery, less postoperative pain scores, and higher incidence of lateral femoral cutaneous nerve injury. The results need to be validated by large‐sample, high‐quality RCT studies, and long‐term follow‐up of complications.https://doi.org/10.1111/os.12669Anterior approachMeta‐analysisPosterior approachTotal hip arthroplasty |
| spellingShingle | Xian‐teng Yang Hai‐feng Huang Li Sun Zhen Yang Chao‐yong Deng Xiao‐bin Tian Direct Anterior Approach Versus Posterolateral Approach in Total Hip Arthroplasty: A Systematic Review and Meta‐analysis of Randomized Controlled Studies Orthopaedic Surgery Anterior approach Meta‐analysis Posterior approach Total hip arthroplasty |
| title | Direct Anterior Approach Versus Posterolateral Approach in Total Hip Arthroplasty: A Systematic Review and Meta‐analysis of Randomized Controlled Studies |
| title_full | Direct Anterior Approach Versus Posterolateral Approach in Total Hip Arthroplasty: A Systematic Review and Meta‐analysis of Randomized Controlled Studies |
| title_fullStr | Direct Anterior Approach Versus Posterolateral Approach in Total Hip Arthroplasty: A Systematic Review and Meta‐analysis of Randomized Controlled Studies |
| title_full_unstemmed | Direct Anterior Approach Versus Posterolateral Approach in Total Hip Arthroplasty: A Systematic Review and Meta‐analysis of Randomized Controlled Studies |
| title_short | Direct Anterior Approach Versus Posterolateral Approach in Total Hip Arthroplasty: A Systematic Review and Meta‐analysis of Randomized Controlled Studies |
| title_sort | direct anterior approach versus posterolateral approach in total hip arthroplasty a systematic review and meta analysis of randomized controlled studies |
| topic | Anterior approach Meta‐analysis Posterior approach Total hip arthroplasty |
| url | https://doi.org/10.1111/os.12669 |
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