The Journal of Hip Surgery 2022; 06(02): 069-075
DOI: 10.1055/s-0042-1748034
Original Article

Surgical Approaches in Primary Total Hip Arthroplasty: Systematic Review of Randomized Controlled Trials

1   Department of Elective Orthopaedic Services, Nottingham University Hospital NHS Trust, City Hospital, Nottingham, United Kingdom
,
Benjamin V. Bloch
1   Department of Elective Orthopaedic Services, Nottingham University Hospital NHS Trust, City Hospital, Nottingham, United Kingdom
,
Simon R. Platt
2   Department of Orthopaedic Surgery, Gold Coast University Hospital, Southport, Australia
,
Peter J. James
2   Department of Orthopaedic Surgery, Gold Coast University Hospital, Southport, Australia
› Author Affiliations
Funding None.

Abstract

The aim of this study was to provide an overview of randomized controlled trials (RCTs) of surgical approaches in primary total hip arthroplasty (THA), summarizing the available high-quality evidence. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we performed the electronic searches in January 2021. We searched the Cochrane Central Register of Controlled Trials (2021, Issue 1), Ovid MEDLINE (including e-pub ahead of print, in-process, and other non-indexed citations, Ovid MEDLINE Daily, Ovid MEDLINE and Versions) (1946–January 20, 2021), and Embase (1980–January 20, 2021). We limited our search to English language literature. We excluded nonrandomized trials, trials on neck of femur fractures or revision surgery, systematic reviews, and meta-analyses. Trials that met our inclusion criteria were assessed using a binary outcome measure of whether they reported statistically significant findings. These were then classified according to the intervention groups. A total of 72 RCTs met the inclusion criteria. The total number of patients in those trials was 6,728. Only five RCTs (5.9%) reported significant differences between the intervention and the control groups. The largest subgroup of trials was minimally invasive versus standard techniques (18 RCTs) with no significant differences. Standard (lateral, posterior) approaches were compared in 23 RCTs with only 1 RCT reporting significant differences. Thirteen RCTs evaluated mini-incisions, with only 1 RCT reporting significant differences, and the remaining 18 RCTs evaluated variations of surgical approaches and interventions, with 3 RCTs reporting significant differences. The evidence reviewed indicates that for the vast majority of patients, a standard THA approach familiar to the surgeon leads to comparable outcomes. Level of evidence is II.

Authors' Contribution

H.E.M. and S.R.P. conceptualized and designed the work, and drafted the manuscript. B.V.B. contributed to data analysis and drafting of the manuscript. P.J.J. conceptualized and drafted the manuscript.




Publication History

Received: 18 August 2021

Accepted: 04 February 2022

Article published online:
14 July 2022

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