Does approach significantly affect cup positioning in total hip arthroplasty ?
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2019;7(3):5 PLoS One. 2018 Jan 29;13(1):e019140180 patients scheduled for primary total hip arthroplasty were randomized to surgery completed through either a lateral approach or a posterior approach. Primary outcomes were cup inclination and anteversion, as well as the number of cups placed outside of Lewinnek "target zone" (40+/-10deg inclination; 15+/-10deg anteversion). While results for mean cup inclination and anteversion demonstrated significant differences between groups, the rate of cups placed outside the Lewinnek safe zone was similar between groups.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
4/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
3/5
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
The approach used in total hip arthroplasty may significantly influence acetabular cup positioning, though few randomized controlled trials have been completed with an emphasis on cup alignment when comparing different approaches. Two of the most common approaches used in THA are the posterior and lateral approaches, and this study sought to compare postoperative acetabular cup angles between the two approaches.
Qual era a principal questão de investigação?
In total hip arthroplasty, does the posterior approach lead to significantly greater cup anteversion and significantly lower cup inclination when compared to the lateral approach?
- Cup anteversion was significantly different between the posterior approach group (15+/-8.4deg) and the lateral approach group (10+/-5.9deg) (p=0.006). A total of 10 cups in the posterior approach group (six <5deg; four >25deg) and 6 cups in the lateral approach group (all <5deg) were outside of the target 15+/-10 deg anteversion.
- Cup inclination was significantly different between the posterior approach group (42+/-5.9deg) and the lateral approach group (47+/-3.6deg). (p<0.001). A total of 4 cups in the posterior approach group and 5 cups (all >50deg) in the lateral approach group (all >50 deg) were outside the target 40+/-10 deg inclination.
- A total of 11 cups in each group were placed outside the target zone.
- Leg length discrepancy did not significantly differ between the posterior approach group (1.9+/-5.2mm) and the lateral approach group (3.4+/-5.0mm).
De que é que me devo lembrar mais?
In total hip arthroplasty, the posterior approach led to significantly lower cup anteversion and lower cup inclination when compared to the lateral approach, but similar rates of cup placement within the Lewinnek target zone were observed between groups.
Como é que isto afectará o tratamento dos meus doentes?
The results of this study suggest that the two approaches do significantly differ in cup angles in total hip arthroplasty, though display similar incidence of cup placement within the Lewinnek safe zone. Longer term follow-up is necessary to determine the impact of the differences in anteversion and inclination between approaches on dislocation rates, as well as clinical and functional outcome measures.
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