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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

Hosam E. Matar 
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
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Funding None.
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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.

Keywords

randomized controlled trials - total hip arthroplasty - surgical approach - systematic review - evidence-based medicine

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

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Laupacis A, Bourne R, Rorabeck C. et al. The effect of elective total hip replacement on health-related quality of life. J Bone Joint Surg Am 1993; 75 (11) 1619-1626
    CrossrefPubMedSearch in Google Scholar
  • 2 Charnley J. Arthroplasty of the hip. A new operation. Lancet 1961; 1 (7187): 1129-1132
    CrossrefPubMedSearch in Google Scholar
  • 3 Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet 2019; 393 (10172): 647-654
    CrossrefPubMedSearch in Google Scholar
  • 4 Altman DG, Schulz KF, Moher D. et al; CONSORT GROUP (Consolidated Standards of Reporting Trials). The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med 2001; 134 (08) 663-694
    CrossrefPubMedSearch in Google Scholar
  • 5 Evidence-Based Medicine Working Group. Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA 1992; 268 (17) 2420-2425
    Search in Google Scholar
  • 6 Prescott RJ, Counsell CE, Gillespie WJ. et al. Factors that limit the quality, number and progress of randomised controlled trials. Health Technol Assess 1999; 3 (20) 1-143
    CrossrefPubMedSearch in Google Scholar
  • 7 McCulloch P, Taylor I, Sasako M, Lovett B, Griffin D. Randomised trials in surgery: problems and possible solutions. BMJ 2002; 324 (7351): 1448-1451
    CrossrefPubMedSearch in Google Scholar
  • 8 Matar HE, Platt SR. Overview of randomised controlled trials in orthopaedic research: search for significant findings. Eur J Orthop Surg Traumatol 2019; 29 (06) 1163-1168
    CrossrefPubMedSearch in Google Scholar
  • 9 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097
    Search in Google Scholar
  • 10 Lefebvre C, Manheimer E, Glanville J. Searching for studies. In: Higgins JPT, Green S. eds. Cochrane Handbook for Systematic Reviews of Interventions. Chap. 6. The Cochrane Collaboration; 2011
    Search in Google Scholar
  • 11 Dienstknecht T, Lüring C, Tingart M, Grifka J, Sendtner E. Total hip arthroplasty through the mini-incision (Micro-hip) approach versus the standard transgluteal (Bauer) approach: a prospective, randomised study. J Orthop Surg (Hong Kong) 2014; 22 (02) 168-172
    CrossrefPubMedSearch in Google Scholar
  • 12 Kruse C, Rosenlund S, Broeng L, Overgaard S. Radiographic cup position following posterior and lateral approach to total hip arthroplasty. An explorative randomized controlled trial. PLoS One 2018; 13 (01) e0191401
    CrossrefPubMedSearch in Google Scholar
  • 13 Moon JK, Kim Y, Hwang KT, Yang JH, Kim YH. The incidence of hip dislocation and suture failure according to two different types of posterior soft tissue repair techniques in total hip arthroplasty: a prospective randomized controlled trial. Int Orthop 2018; 42 (09) 2049-2056
    CrossrefPubMedSearch in Google Scholar
  • 14 Takada R, Jinno T, Miyatake K. et al. Direct anterior versus anterolateral approach in one-stage supine total hip arthroplasty. Focused on nerve injury: a prospective, randomized, controlled trial. J Orthop Sci 2018; 23 (05) 783-787
    CrossrefPubMedSearch in Google Scholar
  • 15 Takada R, Jinno T, Miyatake K. et al. Supine versus lateral position for accurate positioning of acetabular cup in total hip arthroplasty using the modified Watson-Jones approach: a randomized single-blind controlled trial. Orthop Traumatol Surg Res 2019; 105 (05) 915-922
    CrossrefPubMedSearch in Google Scholar
  • 16 Meermans G, Konan S, Das R, Volpin A, Haddad FS. The direct anterior approach in total hip arthroplasty: a systematic review of the literature. Bone Joint J 2017; 99-B (06) 732-740
    CrossrefPubMedSearch in Google Scholar
  • 17 Putananon C, Tuchinda H, Arirachakaran A, Wongsak S, Narinsorasak T, Kongtharvonskul J. Comparison of direct anterior, lateral, posterior and posterior-2 approaches in total hip arthroplasty: network meta-analysis. Eur J Orthop Surg Traumatol 2018; 28 (02) 255-267
    CrossrefPubMedSearch in Google Scholar
  • 18 Xu CP, Li X, Song JQ, Cui Z, Yu B. Mini-incision versus standard incision total hip arthroplasty regarding surgical outcomes: a systematic review and meta-analysis of randomized controlled trials. PLoS One 2013; 8 (11) e80021
    CrossrefPubMedSearch in Google Scholar
  • 19 Herbert RD, Kasza J, Bø K. Analysis of randomised trials with long-term follow-up. BMC Med Res Methodol 2018; 18 (01) 48
    CrossrefPubMedSearch in Google Scholar
  • 20 Lübbeke A, Silman AJ, Prieto-Alhambra D, Adler AI, Barea C, Carr AJ. The role of national registries in improving patient safety for hip and knee replacements. BMC Musculoskelet Disord 2017; 18 (01) 414
    CrossrefPubMedSearch in Google Scholar
  • 21 Pugely AJ, Martin CT, Harwood J, Ong KL, Bozic KJ, Callaghan JJ. Database and registry research in orthopaedic surgery: part 2: clinical registry data. J Bone Joint Surg Am 2015; 97 (21) 1799-1808
    CrossrefPubMedSearch in Google Scholar
  • 22 Inacio MC, Paxton EW, Dillon MT. Understanding orthopaedic registry studies: a comparison with clinical studies. J Bone Joint Surg Am 2016; 98 (01) e3
    CrossrefPubMedSearch in Google Scholar