Total hip arthroplasty: minimally invasive surgery or not? Meta-analysis of clinical trials.
Approach
Exposure
Hip prosthesis
Invasive
Mini
Minimally
Standard
Total hip arthroplasty
Total hip replacement
osteoarthritis
Journal
International orthopaedics
ISSN: 1432-5195
Titre abrégé: Int Orthop
Pays: Germany
ID NLM: 7705431
Informations de publication
Date de publication:
07 2019
07 2019
Historique:
received:
13
04
2018
accepted:
21
08
2018
pubmed:
2
9
2018
medline:
15
2
2020
entrez:
2
9
2018
Statut:
ppublish
Résumé
There exist a relevant number of clinical trials comparing the minimally invasive surgery to the standard-invasive approach in total hip arthroplasty (THA). Up to date, there are still debates concerning the most effective approach in THA. The purpose of this study is to compare the clinical outcomes concerning patients undergoing primary THA performed via the minimally invasive versus standard-invasive surgery incision. The search was performed in the main databases, evaluating both quantitative and qualitative results. All the randomised controlled trials (RCTs) and non-randomised controlled trials (nRCTs) comparing the minimally invasive versus the standard-invasive approach were enrolled in this study. We focused on the clinical and radiological outcomes and on the complication rate. Study methodological quality was assessed performing the PEDro critical appraisal scale. All meta-analyses were performed using the Review Manager software. To analyse the publication's bias, we performed the Funnel plot. We enrolled in our study 4761 patients, undergoing to 4842 total hip arthroplasties. The mean follow-up was 22.26 months. In favour of the minimally invasive group, we reported less total estimated blood loss, shorter surgical duration, and a shorter length of stay. In favour of the standard-invasive group, we reported a higher value of the Harris hip score. Concerning the radiological outcomes, we did not report substantial differences across the two exposures. No difference was observed regarding the risk of femoral fractures, dislocation, and revision rates. We evidenced an increasing risk occurred in an iatrogenic nerve palsy during the minimally invasive approach. Based on currently available evidences concerning the outcomes following THA and the analysis of our results, we stated no remarkable benefits of the minimally invasive compared to the standard-invasive surgery.
Sections du résumé
BACKGROUND
There exist a relevant number of clinical trials comparing the minimally invasive surgery to the standard-invasive approach in total hip arthroplasty (THA). Up to date, there are still debates concerning the most effective approach in THA.
AIM
The purpose of this study is to compare the clinical outcomes concerning patients undergoing primary THA performed via the minimally invasive versus standard-invasive surgery incision.
MATERIAL AND METHODS
The search was performed in the main databases, evaluating both quantitative and qualitative results. All the randomised controlled trials (RCTs) and non-randomised controlled trials (nRCTs) comparing the minimally invasive versus the standard-invasive approach were enrolled in this study. We focused on the clinical and radiological outcomes and on the complication rate. Study methodological quality was assessed performing the PEDro critical appraisal scale. All meta-analyses were performed using the Review Manager software. To analyse the publication's bias, we performed the Funnel plot.
RESULT
We enrolled in our study 4761 patients, undergoing to 4842 total hip arthroplasties. The mean follow-up was 22.26 months. In favour of the minimally invasive group, we reported less total estimated blood loss, shorter surgical duration, and a shorter length of stay. In favour of the standard-invasive group, we reported a higher value of the Harris hip score. Concerning the radiological outcomes, we did not report substantial differences across the two exposures. No difference was observed regarding the risk of femoral fractures, dislocation, and revision rates. We evidenced an increasing risk occurred in an iatrogenic nerve palsy during the minimally invasive approach.
CONCLUSION
Based on currently available evidences concerning the outcomes following THA and the analysis of our results, we stated no remarkable benefits of the minimally invasive compared to the standard-invasive surgery.
Identifiants
pubmed: 30171273
doi: 10.1007/s00264-018-4124-3
pii: 10.1007/s00264-018-4124-3
doi:
Types de publication
Comparative Study
Journal Article
Meta-Analysis
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1573-1582Commentaires et corrections
Type : CommentIn
Références
Rev Chir Orthop Reparatrice Appar Mot. 2007 May;93(3):228-37
pubmed: 17534205
Int Orthop. 2015 Aug;39(8):1475-81
pubmed: 25971655
J Arthroplasty. 2004 Aug;19(5):538-45
pubmed: 15284972
J Orthop Surg Res. 2010 Jul 27;5:46
pubmed: 20663200
Int Orthop. 2006 Jun;30(3):167-71
pubmed: 16552579
Ir J Med Sci. 2010 Jun;179(2):285-90
pubmed: 19847593
Int Orthop. 2018 Feb;42(2):281-287
pubmed: 29285665
J Bone Joint Surg Am. 2009 Mar 1;91 Suppl 2 Pt 1:50-73
pubmed: 19255200
Orthop Clin North Am. 2004 Apr;35(2):153-62
pubmed: 15062701
Z Orthop Ihre Grenzgeb. 2007 Jan-Feb;145(1):74-80
pubmed: 17345547
PLoS One. 2015 Jul 10;10(7):e0132634
pubmed: 26161653
J Bone Joint Surg Br. 2012 Jan;94(1):43-50
pubmed: 22219246
J Arthroplasty. 2006 Dec;21(8):1092-8
pubmed: 17162166
Clin Anat. 2013 Jul;26(5):614-20
pubmed: 22374811
J Bone Joint Surg Am. 2007 Jun;89(6):1153-60
pubmed: 17545416
Int Orthop. 2017 Apr;41(4):699-705
pubmed: 27312191
Acta Orthop Belg. 2005 Feb;71(1):60-4
pubmed: 15792209
Zhongguo Gu Shang. 2016 Aug 25;29(8):702-707
pubmed: 29282927
Int Orthop. 2007 Aug;31 Suppl 1:S13-5
pubmed: 17657491
J Arthroplasty. 2014 Oct;29(10):1970-82
pubmed: 25023783
J Arthroplasty. 2014 Sep;29(9 Suppl):169-72
pubmed: 25007723
Hip Int. 2007 Jan-Mar;17(1):4-8
pubmed: 19197836
J Arthroplasty. 2005 Feb;20(2):139-44
pubmed: 15902851
BMJ Open. 2017 Oct 16;7(10):e014522
pubmed: 29042371
J Arthroplasty. 2017 Sep;32(9):2744-2747
pubmed: 28487089
J Bone Joint Surg Am. 2005 Apr;87(4):701-10
pubmed: 15805196
Orthopade. 2006 Jul;35(7):716, 718-22
pubmed: 16688429
J Arthroplasty. 2003 Feb;18(2):123-8
pubmed: 12629599
J Arthroplasty. 2008 Oct;23(7):1045-9
pubmed: 18534501
Orthop Clin North Am. 2004 Apr;35(2):137-42
pubmed: 15062699
Zhonghua Wai Ke Za Zhi. 2006 Apr 15;44(8):512-5
pubmed: 16784623
Z Orthop Ihre Grenzgeb. 2004 Nov-Dec;142(6):685-90
pubmed: 15614648
An Sist Sanit Navar. 2010 May-Aug;33(2):133-43
pubmed: 20927140
Int Orthop. 2018 Aug;42(8):1943-1948
pubmed: 29307031
J Arthroplasty. 2017 Aug;32(8):2462-2465
pubmed: 28434694
Int Orthop. 2017 Mar;41(3):461-467
pubmed: 27384045
Ortop Traumatol Rehabil. 2007 Jan-Feb;9(1):39-45
pubmed: 17514173
J Orthop Surg (Hong Kong). 2014 Aug;22(2):168-72
pubmed: 25163948
J Orthop Surg (Hong Kong). 2004 Jun;12(1):19-24
pubmed: 15237117
Int Orthop. 2018 Feb;42(2):297-302
pubmed: 28702750
Arch Orthop Trauma Surg. 2009 Dec;129(12):1633-9
pubmed: 19424709
Int Orthop. 2007 Aug;31 Suppl 1:S7-11
pubmed: 17668206
Acta Orthop Traumatol Turc. 2013;47(5):330-3
pubmed: 24164942
Clin Orthop Relat Res. 2010 Dec;468(12):3348-54
pubmed: 20668969
Acta Biomed. 2014 Nov 09;85 Suppl 2:75-80
pubmed: 25409723
J Arthroplasty. 2007 Jun;22(4):490-5
pubmed: 17562403
Int Orthop. 2017 Dec;41(12):2487-2493
pubmed: 28567577
Eur J Orthop Surg Traumatol. 2013 Jan;23(1):47-52
pubmed: 23412407
Acta Orthop. 2016 Jun;87(3):225-30
pubmed: 26848628
Clin Rehabil. 2005 Aug;19(5):465-74
pubmed: 16119401
Int Orthop. 2011 Feb;35(2):173-84
pubmed: 20559827
Phys Ther. 2003 Aug;83(8):713-21
pubmed: 12882612
J Arthroplasty. 2014 Jun;29(6):1256-60
pubmed: 24405626
J Arthroplasty. 2010 Aug;25(5):671-9.e1
pubmed: 20378307
Orthop Rev (Pavia). 2013 Nov 06;5(4):e31
pubmed: 24416475
Injury. 2010 Apr;41(4):365-9
pubmed: 19883910
Clinics (Sao Paulo). 2008 Jun;63(3):351-6
pubmed: 18568245
Clin Orthop Relat Res. 2011 Jan;469(1):200-8
pubmed: 20352383
J Bone Joint Surg Am. 2010 Feb;92(2):328-37
pubmed: 20124059
Int Orthop. 2009 Dec;33(6):1543-7
pubmed: 19148642
Clin Orthop Relat Res. 2010 Feb;468(2):565-70
pubmed: 19330394
Acta Chir Orthop Traumatol Cech. 2009 Aug;76(4):288-94
pubmed: 19755052
Can J Surg. 2015 Apr;58(2):128-39
pubmed: 25799249
J Arthroplasty. 2009 Jun;24(4):528-32
pubmed: 18676112
J Bone Joint Surg Am. 2007 Sep;89(9):1920-7
pubmed: 17768187
J Arthroplasty. 2015 Mar;30(3):419-34
pubmed: 25453632
J Arthroplasty. 2011 Dec;26(8):1362-72
pubmed: 21435823