Which approach of total hip arthroplasty is the best efficacy and least complication?

ARTICLE HIGHLIGHTS

Research background

Various hip approaches have been proposed for total hip arthroplasty. Many systematic reviews and meta-analysis (MAs) reported their benefits for hip function, and pain relief. The disadvantages, such as hip dislocation, intra-operative fracture, blood loss, and nerve injury, depended on types of surgical techniques. This is the first umbrella review comprehensively compared six approaches including direct anterior (DAA), direct superior (DSA)/supercapsular percutaneously-assisted total hip (SuperPath), lateral (LA), mini-lateral (LMIS), 2-incision, and posterior approach (PA) techniques.

Research motivation

Comparisons of different hip approaches, particularly DSA/SuperPath to PA in terms of important clinical outcomes and complications have not yet been in previous network MAs.

Research objectives

To compare hip approaches including DAA, DSA/SuperPath, LA, LMIS, 2-incision, and PA. The best approach is determined by constructing cluster ranking plots between benefits of Harris Hip Score (HHS), and risks of hip dislocation, intra-operative fracture, wound complication, and nerve injury.

Research methods

MA and updated randomized controlled trials (RCTs) were identified from large two databases (MEDLINE and Scopus) up to year 2023. Two evaluators independently assessed the quality, and extracted data from included studies comparing hip approaches, and reporting at least one outcomes of interest. This review was performed with robust methodology by re-pooling data, network MA, surface under cumulative ranking curve, corrected covered area for overlapping studies, and publication bias assessment.

Research results

Considering HHS, clinical important outcomes and complications, re-pooled 47 RCTs demonstrated DAA was the best hip approach followed by DSA/SuperPath. These evidences were from moderate quality RCTs without publication bias. High degree of CCA indicated overlapping between RCTs among previous MAs.

Research conclusions

DSA/SuperPath provided good functional outcome in the middle between PA and DAA. Without learning curve, this approach might be useful for surgeons who are familiar to PA or inexperienced in DAA to avoid adverse outcomes.

Research perspectives

Future study should be conducted to update the information of DSA/SuperPath and directly compare with DAA and PA.