ARTHROPLASTY
Mini-Incision versus Standard Incision Total Hip Arthroplasty Regarding Surgical Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(4):8 PLoS One. 2013 Nov 12;8(11)Fourteen prospective randomized control trials in which patients received total hip arthroplasty through mini-incision (MI) or standard incision (SI) were pooled to determine if mini-incision THA was superior to standard incision THA in general, or through a specific surgical approach. The results of the study indicated that mini-incision THA reduced total blood loss and length of hospital stay. Subgroup analysis of the two treatment methods by surgical approach demonstrated that posterior mini-incision THA led to perioperative advantages in surgical duration, blood loss, and hospital stay. A lateral approach MI THA was also noted to be significantly shorter in surgical duration compared to SI THA. No significant differences in pain medication dose, functional outcomes, radiographic outcomes, or complications were found.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
How would you rate the scientific quality of this evidence?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
4/4
Introduction
4/4
Accessing Data
4/4
Analysing Data
4/4
Results
3/4
Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
The introduction of mini-incision (MI) (defined as 10cm or smaller for the purposes of this study) to total hip arthroplasty remains controversial despite a large amount of existing studies addressing the topic. MI THA may lead to less soft tissue trauma, reduced blood loss, and fewer blood transfusions, along with less postoperative pain after surgery. However, while there are these benefits with the MI treatment, certain risks have been suggested to be associated with its use, such as increased complications due to component malpositioning. Studies comparing MI THA to standard incision (SI) THA have provided varying results on the two treatment methods, possibly due to a lack of exclusion or separation of surgical approach methods. The goal of this meta-analysis was to determine if MI THA was superior to SI THA in general, or through a specific surgical approach.
¿Cuál era la pregunta principal de la investigación?
Is mini-incision THA superior to standard incision THA in general, or through a specific surgical approach?
¿Cuáles fueron los hallazgos importantes?
- Eleven studies (n=1039) were included in a meta-analysis of surgical duration. Overall, no significant difference was found between the MI and SI THA regarding surgical duration (WMD -2.32 min [95%CI -6.98, 2.33]; p=0.33, I-squared=90%). Based on surgical approach, significantly shorter surgical durations were noted for MI THA using a posterior approach (WMD, -5.56 min [95%CI -8.45. -2.67] p<0.001; I-squared=0%) or lateral approach (WMD -15.56 min [95%CI -20.91, -10.21]; p<0.001; I-squared=0%). The difference between groups was not significant for postero- or anterolateral approaches (p>0.05)
- Eleven trials (n=556) were suitable for meta-analysis for total blood loss. Overall, total blood loss was significantly lower in the MI group compared to SI THA (WMD -111.51 mL [95%CI -201.83, -21.18]; p=0.02; I-squared= 84%). Based on approach subgroups, the only approach which displayed statistically significantly lower total blood loss with MI THA was a posterior approach (WMD -54.46 mL [95%CI -107.20, -1.73]; p=0.04; I-squared= 0%).
- Six trials (n=528) were pooled to analyze doses of pain medication. No significant difference regarding pain medication doses between treatment arms were found (SMD -0.14 [95%CI -0.47, 0.19]; p=0.40; I-squared= 68%). Pooling was only possible for the posterior approach subgroup, which also displayed no significant differences between MI and SI THA (SMD -0.08 [95%CI -0.40, 0.24]; p=0.61, I-squared 42%)
- Results from 5 studies (n=522) indicated a significantly reduced length of hospital stay with MI THA when compared to patients receiving SI THA (WMD -0.38 days [95%CI -0.67, -0.08]; p=0.01). Subgroup analysis of two RCTs revealed a significant difference between groups for posterior approach in terms of hospital stay (WMD -0.40 days [95% CI -0.74, -0.06]; p=0.002).
- Ten trials (n=917) were pooled to compare functional outcome in the two treatment arms. No significant difference between the groups was found (WMD 0.72 [95%CI -0.79 to 2.23]; p=0.35). Subgroup analyses based on surgical approaches also revealed no significant difference.
- No significant differences between MI and SI groups were found when looking at outliers of acetabular cup abduction (5 trials; p=0.56), outliers of cup anteversion (2 trials; p=0.69), outliers of femoral prosthesis position (9 trials; p=0.27), femoral offset (3 trials; p=0.15), or leg length discrepancy (4 trials; p=0.75). Results from one study indicated a significant difference between posterolateral MI and SI subgroups regarding femoral offset (WMD 3.00mm [95%CI 0.40, 5.60]; p=0.02).
- No significant difference between groups regarding infection (p=0.25), dislocation (p=0.60), nerve injury (p=0.24) proximal femoral fracture (p=0.61), DVT (p=0.25) component loosening (p=0.38), revision (p=0.40) or heterotopic ossification (p=0.58) were found.
¿Qué es lo que más debo recordar?
Results of the meta-analysis indicated that mini-incision THA reduced total blood loss and length of hospital stay, particularly when a posterior approach was used. Mini-incision THA using a lateral surgical approach also appeared to significantly reduce operative time. No significant differences in pain medication dose, functional outcomes, radiographic outcomes, or complications were found.
¿Cómo afectará esto al cuidado de mis pacientes?
While no definite conclusion can be made on the superiority of mini-incision THA to standard incision THA, the evidence presented suggests that posterior mini-incision THA may reduce surgical duration, blood loss, and hospital stay. The follow-up durations of the included studies ranged from 1.5 months to 5 years; thus subsequent long-term analyses of mini-incision versus standard incision THA are warranted to determine the efficacy of these treatments over an extended period of time. More sufficiently-powered trials are also needed to gain a better perspective of the potential differences between these treatment methods.
DESCARGO DE RESPONSABILIDAD
El contenido de esta página tiene únicamente fines informativos y no pretende sustituir el consejo, diagnóstico o tratamiento médico profesional. Si necesita tratamiento médico, busque siempre el consejo de su médico o acuda al servicio de urgencias más cercano. Las opiniones, creencias y puntos de vista expresados por las personas sobre el contenido que se encuentra en esta página no reflejan las opiniones, creencias y puntos de vista de OrthoEvidence.
0 de 4 artículos mensuales GRATIS desbloqueados
