Nitiwarangkul L, Hongku N, Pattanaprateep O, Rattanasiri S, Woratanarat P, Thakkinstian A. Which approach of total hip arthroplasty is the best efficacy and least complication? World J Orthop 2024; 15(1): 73-93 [PMID: 38293261 DOI: 10.5312/wjo.v15.i1.73]
Corresponding Author of This Article
Patarawan Woratanarat, MD, PhD, Professor, Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand. pataraw@yahoo.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Lertkong Nitiwarangkul, Oraluck Pattanaprateep, Sasivimol Rattanasiri, Ammarin Thakkinstian, Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Lertkong Nitiwarangkul, Orthopaedics Surgery, Police General Hospital, Bangkok 10330, Thailand
Natthapong Hongku, Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindrahiraj University, Bangkok 10300, Thailand
Patarawan Woratanarat, Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Author contributions: Thakkinstian A and Woratanarat P contributed to acquisition of conception and design of the study; Hongku N contributed to acquisition of content knowledge approval; Nitiwarangkul L and Hongku N contributed to update searching; Nitiwarangkul L contributed to acquisition of data retrieval, analysis, and interpretation; Rattanasiri S contributed to acquisition of statistical analysis; Nitiwarangkul L and Woratanarat P drafted the article; Pattanaprateep O, Rattanasiri S, Thakkinstian A, and Woratanarat P critically revised the manuscript; and all authors have read and approve the final manuscript.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2020 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Patarawan Woratanarat, MD, PhD, Professor, Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand. pataraw@yahoo.com
Received: November 18, 2023 Peer-review started: November 18, 2023 First decision: December 7, 2023 Revised: December 20, 2023 Accepted: December 29, 2023 Article in press: December 29, 2023 Published online: January 18, 2024 Processing time: 58 Days and 16.8 Hours
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.
