J Korean Med Sci.  2020 Apr;35(18):e111. 10.3346/jkms.2020.35.e111.

Disadvantage during Perioperative Period of Total Hip Arthroplasty Using the Direct Anterior Approach:a Network Meta-Analysis

• Cha Y
• Yoo JI
• Kim JT
• Park CH
• Choy W
• Ha YC
• Koo KH

• KMID: 2500215
• DOI: http://doi.org/10.3346/jkms.2020.35.e111

Abstract

Background
The purpose of this study was to analyze complications of complete hip arthroplasty through systematic review and network meta-analysis of comparative studies of direct anterior approach (DAA), anterolateral approach (LA), and posterolateral approach (PA).
Methods
Prospective randomized controlled trials (RCTs) or quasi-experimental designs evaluating clinical outcomes of DAA, LA, and PA for complete hip arthroplasty are valid if they meet the following criteria: 1) Comparison of clinical outcomes between the three methods for main complete hip arthroplasty (total hip arthroplasty, THA); 2) Compared at least one of the following outcomes: blood loss, operating time, and transfusion volume; 3) Sufficient data were available to extract and pool, i.e., mean reported, standard deviation and number of subjects. A network meta-analysis was used to determine the results of treatment across various surgical approaches. Indirect comparisons between the two surgical approaches was made by borrowing details from the standard comparator (i.e., the posterior approach).
Results
Eight prospective RCTs were included in the meta-analysis of the network. The operation time of the LA was longer than that of PA (standardized mean difference [SMD], 0.96; 95% confidence interval [CI], 0.74–1.18; P < 0.001). DAA also had significantly longer operation time than PA (SMD, 0.45; 95% CI, 0.24–0.66; P < 0.001). However, blood loss of the DAA was the highest compared to other approaches (SMD, 0.60; 95% CI, 0.39–0.82; P = 0.002).
Conclusion
When performing THA with DAA, we should pay attention to increased operation time and blood loss.

Keyword

Total Hip Arthroplasty; Direct Anterior; Anterolateral; Harding; Gait Analysis

Figure

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  Fig. 1 Preferred reporting items for systematic reviews flow diagram representing details of the process of relevant clinical study selection.

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  Fig. 2 Network meta-analysis and plots for operation time after primary total hip arthroplasty.DAA = direct anterior approach, LA = anterolateral approach, PA = posterolateral approach, SMD = standardized mean difference, CI = confidence interval.

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  Fig. 3 Network meta-analysis and plots for blood loss after primary total hip arthroplasty.DAA = direct anterior approach, LA = anterolateral approach, PA = posterolateral approach, CI = confidence interval, SMD = standardized mean difference.

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