Direct anterior approach vs. SuperPATH vs. conventional approaches in total hip replacement: A network meta-analysis of randomized controlled trials.

Acetabulum / surgery Arthroplasty, Replacement, Hip / methods Humans Network Meta-Analysis Randomized Controlled Trials as Topic Treatment Outcome
Approach Direct anterior approach Meta-analysis Network SuperPATH THA

Journal

Orthopaedics & traumatology, surgery & research : OTSR
ISSN: 1877-0568
Titre abrégé: Orthop Traumatol Surg Res
Pays: France
ID NLM: 101494830

Informations de publication

Date de publication:
12 2021
Historique:
received: 10 02 2021
revised: 09 04 2021
accepted: 23 04 2021
pubmed: 19 9 2021
medline: 11 3 2022
entrez: 18 9 2021
Statut: ppublish

Résumé

Two minimally invasive approaches showed some advantages in outcomes compared to conventional approaches (CAs) - the direct anterior approach (DAA) and the supercapsular percutaneously assisted approach in THA (SuperPATH). To the best of our knowledge, these three approaches have never been ranked in a network meta-analysis (NMA) before. Therefore, we conducted a systematic review and NMA of randomized controlled trials comparing short-term outcomes of DAA, SuperPATH and CAs in total hip joint arthroplasty (THA), using CAs as common comparator. A systematic literature search up to February 2021 was performed to identify randomized controlled trials (RCTs) comparing DAA with CAs and SuperPATH with CAs in THA. We measured surgical, functional and radiological outcomes. A NMA, using frequentist methods was performed to assess treatment effects between DAA, SuperPATH and CAs. Information was borrowed from the above-mentioned RCTs, using the CA group as a common comparator. A total of 24 RCTs involving 2,074 patients met the inclusion criteria, six trials with a level I evidence, 18 trials with level II evidence. SuperPATH reduced operation time (fixed effects model: MD=8.1, 95% CI: 5.7 to 10.4), incision length (fixed effects model: MD=2.7, 95%CI: 2.5 to 2.9; random effects model: MD=4.1, 95%CI: 0.6 to 7.6), intraoperative blood loss (fixed effects model: MD=157, 95%CI: 139.2 to 174.2; random effects model: MD=129, 95%CI: 11.5 to 245.7) and early pain intensity (VAS 1 day postoperatively with a fixed effects model: MD=0.8, 95%CI: 0.4 to 1.2) compared to DAA. The two approaches did not differ in functional outcome and in acetabular cup inclination positioning. Our overall findings suggest that short-term outcomes of THA through SuperPATH were superior to DAA and CAs and that short-term outcomes of THA through DAA were superior to CAs. II; systematic review with level I studies and level II studies.

Sections du résumé

BACKGROUND
Two minimally invasive approaches showed some advantages in outcomes compared to conventional approaches (CAs) - the direct anterior approach (DAA) and the supercapsular percutaneously assisted approach in THA (SuperPATH). To the best of our knowledge, these three approaches have never been ranked in a network meta-analysis (NMA) before. Therefore, we conducted a systematic review and NMA of randomized controlled trials comparing short-term outcomes of DAA, SuperPATH and CAs in total hip joint arthroplasty (THA), using CAs as common comparator.
METHODS
A systematic literature search up to February 2021 was performed to identify randomized controlled trials (RCTs) comparing DAA with CAs and SuperPATH with CAs in THA. We measured surgical, functional and radiological outcomes. A NMA, using frequentist methods was performed to assess treatment effects between DAA, SuperPATH and CAs. Information was borrowed from the above-mentioned RCTs, using the CA group as a common comparator.
RESULTS
A total of 24 RCTs involving 2,074 patients met the inclusion criteria, six trials with a level I evidence, 18 trials with level II evidence. SuperPATH reduced operation time (fixed effects model: MD=8.1, 95% CI: 5.7 to 10.4), incision length (fixed effects model: MD=2.7, 95%CI: 2.5 to 2.9; random effects model: MD=4.1, 95%CI: 0.6 to 7.6), intraoperative blood loss (fixed effects model: MD=157, 95%CI: 139.2 to 174.2; random effects model: MD=129, 95%CI: 11.5 to 245.7) and early pain intensity (VAS 1 day postoperatively with a fixed effects model: MD=0.8, 95%CI: 0.4 to 1.2) compared to DAA. The two approaches did not differ in functional outcome and in acetabular cup inclination positioning.
CONCLUSIONS
Our overall findings suggest that short-term outcomes of THA through SuperPATH were superior to DAA and CAs and that short-term outcomes of THA through DAA were superior to CAs.
LEVEL OF EVIDENCE
II; systematic review with level I studies and level II studies.

Identifiants

DOI: 10.1016/j.otsr.2021.103058 PMID: 34536596
pubmed: 34536596
pii: S1877-0568(21)00303-0
doi: 10.1016/j.otsr.2021.103058
pii:
doi:

Types de publication

Journal Article Meta-Analysis Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

103058

Informations de copyright

Copyright © 2021 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.

Auteurs

Nikolai Ramadanov (N)

Department of Emergency Medicine, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, 07747 Jena, Germany. Electronic address: nikolai.ramadanov@gmail.com.

Simon Bueschges (S)

Faculty of Medicine, Department of Statistics, University of Salamanca, Calle Espejo 2, 37007 Salamanca, Spain.

Kuiliang Liu (K)

Department for Orthopaedics and Trauma Surgery, Siloah St. Trudpert Hospital, Wilferdinger Str. 67, 75179 Pforzheim, Germany.

Philip Lazaru (P)

Center for Surgery, Evangelical Hospital Ludwigsfelde-Teltow, Albert-Schweizer-Str. 40-44, 14974 Ludwigsfelde, Germany.

Ivan Marintschev (I)

Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, 07747 Jena, Germany.

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Classifications MeSH

questionsmedicales.fr › Appareil locomoteur › Squelette › Os du membre inférieur › Os coxal › Acétabulum › Direct anterior approach vs. SuperPATH vs....
questionsmedicales.fr › Procédures de chirurgie opératoire › Implantation de prothèse › Arthroplastie prothétique › Arthroplastie prothétique de hanche › Direct anterior approach vs. SuperPATH vs....
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Direct anterior approach vs. SuperPATH vs....
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Méthodologie en recherche épidémiologique › Méta-analyse comme sujet › Méta-analyse en réseau › Direct anterior approach vs. SuperPATH vs....
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études cliniques comme sujet › Essais cliniques comme sujet › Essais cliniques contrôlés comme sujet › Essais contrôlés randomisés comme sujet › Direct anterior approach vs. SuperPATH vs....
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Direct anterior approach vs. SuperPATH vs....