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Short-term outcomes vary by surgical approach in total hip arthroplasty: a network meta-analysis

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

The direct anterior approach (DAA) has increased in popularity in recent years. Proponents cite its muscle-sparing approach and purported reduction in pain and improvement in function when compared to the traditional surgical approaches. There remains controversy surrounding the validity of these claims. The objective of this study was to compare the common total hip surgical approaches in terms of pain scores, functional outcomes, opioid use and complications within the first 12 weeks postoperatively.

Methods

A network meta-analysis of randomized controlled trials (RCT) comparing postoperative outcomes of different surgical approaches in primary THA up to 12 weeks was performed. PubMed, MEDLINE, Embase, Web of Science and SCOPUS were systematically searched from inception to May 2020. Outcomes included pain scores, functional outcome scores, length of stay (LOS), complications and opioid consumption.

Results

Twenty-five RCTs (n = 2339) were included. The DAA demonstrated statistically significant improvement in Harris Hip Scores at 6 weeks when compared to the posterior and direct lateral approaches. The DAA reduced pain scores on postoperative day 2 and at 2 weeks compared to the direct lateral approach. The anterolateral approach was found to have a significantly shorter LOS compared to the other major surgical approaches. The differences in functional outcomes or pain scores did not surpass conventional cutoffs for a minimal clinically important difference.

Conclusion

The DAA led to functional improvements at 6 weeks compared to the posterior and direct lateral approaches and reduced postoperative pain compared to the direct lateral approach. However, these improvements failed to reach clinical significance. All major surgical approaches led to large improvements in function by 12 weeks with relatively low complication rates. Whether a short-term statistically significant improvement in function is sufficiently patient important to recommend DAA as a standard remains uncertain.

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This research did not receive and specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, St. Joseph’s Hospital, Room G522, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada

    Aaron Gazendam, Anthony Bozzo, Seper Ekhtiari, Daniel Tushinski & Mohit Bhandari

  2. McMaster Medical School, McMaster University, Hamilton, ON, Canada

    Colin Kruse

  3. Near East University Hospital, North Nicosia, Turkey

    Nancy Hiasat

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Contributions

All the authors have made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted. The manuscript, including related data, figures and tables has not been previously published and is not under consideration elsewhere.

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Correspondence to Aaron Gazendam.

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The author (M.B.) declares research support from Sanofi, Ferring Pharmaceuticals, DJ Orthopaedics, Acumed, Anika, Flexion and is an associate editor for JBJS Reviews. All the other authors have no conflicts to declare. All the other authors (A.G., A.B., S.E., C.K., N.H., and D.T) report no conflicts of interest.

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Gazendam, A., Bozzo, A., Ekhtiari, S. et al. Short-term outcomes vary by surgical approach in total hip arthroplasty: a network meta-analysis. Arch Orthop Trauma Surg 142, 2893–2902 (2022). https://doi.org/10.1007/s00402-021-04131-4

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