A meta-analysis on RCTs of direct anterior and conventional approaches in total hip arthroplasty
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2021;9(22):5 Sci Rep. 2021 Oct 25;11(1): 20991.What this means for my practice?
The results of this meta-analysis suggest that direct anterior approach provided similar pain, function, radiological, and safety outcomes compared to conventional approaches, albeit with a longer associated operative time, in total hip arthroplasty patients. This study was limited by the lack of long term outcomes, lack of data on hospitalization time and gait, and aggregation of all conventional approaches into one group. Future studies investigating the long term effects of direct anterior approach vs specific conventional approaches are of interest.
Study Summary
1053 total hip arthroplasty patients across 10 randomized controlled trials were included in this meta-analysis comparing the direct anterior approach to conventional approaches. Outcomes of interest included operative time, incision length, intra-operative blood loss, Harris Hip Scores (HHS), pain on a Visual Analog Scale (VAS) at day 1 post-operation, acetabular cup angle, and complications. Pooled results revealed no significant differences between groups in incision length, intra-operative blood loss, HHS scores up to 12 months post-operation, VAS pain scores on day 1 post-operation, complication rate, or acetabular cup inclination angle. Operative time was significantly longer, and acetabular cup anteversion angle significantly smaller, in the direct anterior approach group.
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