Abstract
Introduction
Although there is anatomical individuality among patients, some standardized requirements for component orientation for total hip arthroplasty (THA) exist. To date, no study has compared implant positioning using a network meta-analysis (NMA). Hence, the purpose of this study was to perform a NMA comparing implant positioning among the various approaches for THA.
Methods
This study was conducted according to the PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions. All randomized (RCT) and non-randomized (nRCT) clinical trials comparing two or more different approaches for THA were considered for inclusion. For the statistical analysis, the STATA Software/ MP, Version 14.1 (Stata Corporation, College Station, Texas, USA) was used. The NMA was performed through a Stata routine for Bayesian hierarchical random-effects model analysis.
Results
We enrolled in the present study, a total of 4060 patients, with a mean of 17.84 ± 16.41 months follow-up. The patient baseline data were very homogeneous across the groups concerning age (P = 0.91), sex (P = 0.52), and BMI (P = 0.83). Concerning the cup anteversion, the anterolateral approach reported the value closest to the reference value. The test for overall inconsistency, however, was not statistically significant (P = 0.30). Concerning cup inclination, the lateral approach reported the value closest to the reference value. The test for overall inconsistency was statistically significant (P = 0.01).
Conclusion
The anterolateral approach for total hip arthroplasty detected the best femoral stem alignment and cup anteversion. Data concerning cup inclination detected no sufficient transitivity to draw consistent conclusions.
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References
Hung CC, Wang CY, Fu SH, Yang RS, Hsiao FY (2018) Effects of anti-osteoporosis medications on total hip arthroplasty risks in osteoporotic patients with hip osteoarthritis in Taiwan: a nationwide cohort study. Arch Osteoporos 13(1):107. https://doi.org/10.1007/s11657-018-0522-9
Shigemura T, Yamamoto Y, Murata Y, Sato T, Tsuchiya R, Mizuki N, Toki Y, Wada Y (2018) Total hip arthroplasty after failed transtrochanteric rotational osteotomy for osteonecrosis of the femoral head: A systematic review and meta-analysis. Orthop Traumatol Surg Res. https://doi.org/10.1016/j.otsr.2018.06.019
Moretti VM, Post ZD (2017) Surgical Approaches for Total Hip Arthroplasty. Indian J Orthop 51(4):368–376. https://doi.org/10.4103/ortho.IJOrtho_317_16
Connolly KP, Kamath AF (2016) Direct anterior total hip arthroplasty: comparative outcomes and contemporary results. World J Orthop 7(2):94–101. https://doi.org/10.5312/wjo.v7.i2.94
Miller LE, Gondusky JS, Kamath AF, Boettner F, Wright J, Bhattacharyya S (2018) Influence of surgical approach on complication risk in primary total hip arthroplasty. Acta Orthop 89(3):289–294. https://doi.org/10.1080/17453674.2018.1438694
Wang Z, Hou JZ, Wu CH, Zhou YJ, Gu XM, Wang HH, Feng W, Cheng YX, Sheng X, Bao HW (2018) A systematic review and meta-analysis of direct anterior approach versus posterior approach in total hip arthroplasty. J Orthop Surg Res 13(1):229. https://doi.org/10.1186/s13018-018-0929-4
Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60(2):217–220
Huang SG, Chen B, Lv D, Zhang Y, Nie FF, Li W, Lv Y, Zhao HL, Liu HM (2017) Evaluation of shoulder function in clavicular fracture patients after six surgical procedures based on a network meta-analysis. Disabil Rehabil 39(2):105–112. https://doi.org/10.3109/09638288.2016.1140827
Feng W, Wu K, Liu Z, Kong G, Deng Z, Chen S, Wu Y, Chen M, Liu S, Wang H (2015) Oral direct factor xa inhibitor versus enoxaparin for thromboprophylaxis after hip or knee arthroplasty: systemic review, traditional meta-analysis, dose-response meta-analysis and network meta-analysis. Thromb Res 136(6):1133–1144. https://doi.org/10.1016/j.thromres.2015.10.009
Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, Ioannidis JP, Straus S, Thorlund K, Jansen JP, Mulrow C, Catala-Lopez F, Gotzsche PC, Dickersin K, Boutron I, Altman DG, Moher D (2015) The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 162(11):777–784. https://doi.org/10.7326/M14-2385
Howick J CI, Glasziou P, Greenhalgh T, Carl Heneghan, Liberati A, Moschetti I, Phillips B, Thornton H, Goddard O, Hodgkinson M (2011) The 2011 Oxford CEBM Levels of Evidence. Oxford Centre for Evidence-Based Medicine Available at https://www.cebmnet/indexaspx?o=5653
de Morton NA (2009) The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother 55(2):129–133. https://doi.org/10.1016/s0004-9514(09)70043-1
Chaimani A, Higgins JP, Mavridis D, Spyridonos P, Salanti G (2013) Graphical tools for network meta-analysis in STATA. PLoS ONE 8(10):e76654. https://doi.org/10.1371/journal.pone.0076654
Barrett WP, Turner SE, Leopold JP (2013) Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplast 28(9):1634–1638. https://doi.org/10.1016/j.arth.2013.01.034
Bergin PF, Doppelt JD, Kephart CJ, Benke MT, Graeter JH, Holmes AS, Haleem-Smith H, Tuan RS, Unger AS (2011) Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage markers. J Bone Joint Surg Am 93(15):1392–1398. https://doi.org/10.2106/JBJS.J.00557
Cheng TE, Wallis JA, Taylor NF, Holden CT, Marks P, Smith CL, Armstrong MS, Singh PJ (2017) A prospective randomized clinical trial in total hip arthroplasty—comparing early results between the direct anterior approach and the posterior approach. J Arthroplast 32(3):883–890. https://doi.org/10.1016/j.arth.2016.08.027
Dienstknecht T, Luring C, Tingart M, Grifka J, Sendtner E (2014) Total hip arthroplasty through the mini-incision (Micro-hip) approach versus the standard transgluteal (Bauer) approach: a prospective, randomised study. J Orthop Surg 22(2):168–172. https://doi.org/10.1177/230949901402200210
Fink B, Mittelstaedt A (2012) Minimally invasive posterior approach for total hip arthroplasty. Orthopade 41(5):382–389. https://doi.org/10.1007/s00132-011-1893-4
Goosen JH, Kollen BJ, Castelein RM, Kuipers BM, Verheyen CC (2011) Minimally invasive versus classic procedures in total hip arthroplasty: a double-blind randomized controlled trial. Clin Orthop Relat Res 469(1):200–208. https://doi.org/10.1007/s11999-010-1331-7
Gore DR, Murray MP, Sepic SB, Gardner GM (1982) Anterolateral compared to posterior approach in total hip arthroplasty: differences in component positioning, hip strength, and hip motion. Clin Orthop Relat Res 165:180–187
Hananouchi T, Takao M, Nishii T, Miki H, Iwana D, Yoshikawa H, Sugano N (2009) Comparison of navigation accuracy in THA between the mini-anterior and -posterior approaches. Int J Med Robot 5(1):20–25. https://doi.org/10.1002/rcs.226
Ilchmann T, Gersbach S, Zwicky L, Clauss M (2013) Standard transgluteal versus minimal invasive anterior approach in hip arthroplasty: a prospective. Consecutive Cohort Study Orthop Rev 5(4):e31. https://doi.org/10.4081/or.2013.e31
Ji HM, Kim KC, Lee YK, Ha YC, Koo KH (2012) Dislocation after total hip arthroplasty: a randomized clinical trial of a posterior approach and a modified lateral approach. J Arthroplast 27(3):378–385. https://doi.org/10.1016/j.arth.2011.06.007
Joseph NM, Roberts J, Mulligan MT (2017) Financial impact of total hip arthroplasty: a comparison of anterior versus posterior surgical approaches. Arthroplast Today 3(1):39–43. https://doi.org/10.1016/j.artd.2016.01.002
Laffosse JM, Accadbled F, Molinier F, Chiron P, Hocine B, Puget J (2008) Anterolateral mini-invasive versus posterior mini-invasive approach for primary total hip replacement comparison of exposure and implant positioning. Arch Orthop Trauma Surg 128(4):363–369. https://doi.org/10.1007/s00402-007-0385-9
Leuchte S, Luchs A, Wohlrab D (2007) Measurement of ground reaction forces after total hip arthroplasty using different surgical approaches. Z Orthop Ihre Grenzgeb 145(1):74–80. https://doi.org/10.1055/s-2007-960511
Martin R, Clayson PE, Troussel S, Fraser BP, Docquier PL (2011) Anterolateral minimally invasive total hip arthroplasty: a prospective randomized controlled study with a follow-up of 1 year. J Arthroplast 26(8):1362–1372. https://doi.org/10.1016/j.arth.2010.11.016
Martin CT, Pugely AJ, Gao Y, Clark CR (2013) A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. J Arthroplast 28(5):849–854. https://doi.org/10.1016/j.arth.2012.10.029
Nakata K, Nishikawa M, Yamamoto K, Hirota S, Yoshikawa H (2009) A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplast 24(5):698–704. https://doi.org/10.1016/j.arth.2008.04.012
Nam D, Sculco PK, Abdel MP, Alexiades MM, Figgie MP, Mayman DJ (2013) Leg-length inequalities following THA based on surgical technique. Orthopedics 36(4):e395–400. https://doi.org/10.3928/01477447-20130327-11
Pogliacomi F, De Filippo M, Paraskevopoulos A, Alesci M, Marenghi P, Ceccarelli F (2012) Mini-incision direct lateral approach versus anterior mini-invasive approach in total hip replacement: results 1 year after surgery. Acta Biomed 83(2):114–121
Rathod PA, Bhalla S, Deshmukh AJ, Rodriguez JA (2014) Does fluoroscopy with anterior hip arthroplasty decrease acetabular cup variability compared with a nonguided posterior approach? Clin Orthop Relat Res 472(6):1877–1885. https://doi.org/10.1007/s11999-014-3512-2
Rathod PA, Orishimo KF, Kremenic IJ, Deshmukh AJ, Rodriguez JA (2014) Similar improvement in gait parameters following direct anterior & posterior approach total hip arthroplasty. J Arthroplast 29(6):1261–1264. https://doi.org/10.1016/j.arth.2013.11.021
Reichert JC, von Rottkay E, Roth F, Renz T, Hausmann J, Kranz J, Rackwitz L, Noth U, Rudert M (2018) A prospective randomized comparison of the minimally invasive direct anterior and the transgluteal approach for primary total hip arthroplasty. BMC Musculoskelet Disord 19(1):241. https://doi.org/10.1186/s12891-018-2133-4
Rittmeister M, Peters A (2006) Comparison of total hip arthroplasty via a posterior mini-incision versus a classic anterolateral approach. Orthopade 35(7):716–718 722. https://doi.org/10.1007/s00132-006-0963-5
Rodriguez JA, Deshmukh AJ, Rathod PA, Greiz ML, Deshmane PP, Hepinstall MS, Ranawat AS (2014) Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach? Clin Orthop Relat Res 472(2):455–463. https://doi.org/10.1007/s11999-013-3231-0
Schleicher I, Haas H, Adams TS, Szalay G, Klein H, Kordelle J (2011) Minimal-invasive posterior approach for total hip arthroplasty versus standard lateral approach. Acta Orthop Belg 77(4):480–487
Sendtner E, Borowiak K, Schuster T, Woerner M, Grifka J, Renkawitz T (2011) Tackling the learning curve: comparison between the anterior, minimally invasive (Micro-hip(R)) and the lateral, transgluteal (Bauer) approach for primary total hip replacement. Arch Orthop Trauma Surg 131(5):597–602. https://doi.org/10.1007/s00402-010-1174-4
Spaans AJ, van den Hout JA, Bolder SB (2012) High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach. Acta Orthop 83(4):342–346. https://doi.org/10.3109/17453674.2012.711701
Sugano N, Takao M, Sakai T, Nishii T, Miki H, Nakamura N (2009) Comparison of mini-incision total hip arthroplasty through an anterior approach and a posterior approach using navigation. Orthop Clin North Am 40(3):365–370. https://doi.org/10.1016/j.ocl.2009.04.003
Takada R, **no T, Miyatake K, Hirao M, Kimura A, Koga D, Yagishita K, Okawa A (2018) Direct anterior versus anterolateral approach in one-stage supine total hip arthroplasty focused on nerve injury: a prospective, randomized, controlled trial. J Orthop Sci 23(5):783–787. https://doi.org/10.1016/j.jos.2018.05.005
Taunton MJ, Mason JB, Odum SM, Springer BD (2014) Direct anterior total hip arthroplasty yields more rapid voluntary cessation of all walking aids: a prospective, randomized clinical trial. J Arthroplasty 29(9 Suppl):169–172. https://doi.org/10.1016/j.arth.2014.03.051
Yang CF, Zhu QS, Han YS, Zhu JY, Wang HQ, Cong R, Zhang DW (2009) Anterolateral minimally-invasive total hip arthroplasty: a clinical comparative study of 110 cases. Zhonghua Yi Xue Za Zhi 89(1):2–6
Zhao HY, Kang PD, **a YY, Shi XJ, Nie Y, Pei FX (2017) Comparison of early functional recovery after total hip arthroplasty using a direct anterior or posterolateral approach: a randomized controlled trial. J Arthroplast 32(11):3421–3428. https://doi.org/10.1016/j.arth.2017.05.056
Mirza SB, Dunlop DG, Panesar SS, Naqvi SG, Gangoo S, Salih S (2010) Basic science considerations in primary total hip replacement arthroplasty. Open Orthop J 4:169–180. https://doi.org/10.2174/1874325001004010169
Bonnin MP, Archbold PH, Basiglini L, Fessy MH, Beverland DE (2012) Do we medialise the hip centre of rotation in total hip arthroplasty? Influence of acetabular offset and surgical technique. Hip Int 22(4):371–378. https://doi.org/10.5301/HIP.2012.9350
Bonnin MP, Archbold PH, Basiglini L, Selmi TA, Beverland DE (2011) Should the acetabular cup be medialised in total hip arthroplasty. Hip Int 21(4):428–435. https://doi.org/10.5301/HIP.2011.8582
Kurtz WB, Ecker TM, Reichmann WM, Murphy SB (2010) Factors affecting bony im**ement in hip arthroplasty. J Arthroplast 25(4):624–634. https://doi.org/10.1016/j.arth.2009.03.024
Abolghasemian M, Samiezadeh S, Jafari D, Bougherara H, Gross AE, Ghazavi MT (2013) Displacement of the hip center of rotation after arthroplasty of Crowe III and IV dysplasia: a radiological and biomechanical study. J Arthroplasty 28(6):1031–1035. https://doi.org/10.1016/j.arth.2012.07.042
Asayama I, Chamnongkich S, Simpson KJ, Kinsey TL, Mahoney OM (2005) Reconstructed hip joint position and abductor muscle strength after total hip arthroplasty. J Arthroplasty 20(4):414–420. https://doi.org/10.1016/j.arth.2004.01.016
Sexton SA, Yeung E, Jackson MP, Rajaratnam S, Martell JM, Walter WL, Zicat BA, Walter WK (2011) The role of patient factors and implant position in squeaking of ceramic-on-ceramic total hip replacements. J Bone Joint Surg Br 93(4):439–442. https://doi.org/10.1302/0301-620X.93B4.25707
Walter WL, O'Toole GC, Walter WK, Ellis A, Zicat BA (2007) Squeaking in ceramic-on-ceramic hips: the importance of acetabular component orientation. J Arthroplast 22(4):496–503. https://doi.org/10.1016/j.arth.2006.06.018
Parvizi J, Sharkey PF, Bissett GA, Rothman RH, Hozack WJ (2003) Surgical treatment of limb-length discrepancy following total hip arthroplasty. J Bone Joint Surg Am 85-A 12(2310):2317
Little NJ, Busch CA, Gallagher JA, Rorabeck CH, Bourne RB (2009) Acetabular polyethylene wear and acetabular inclination and femoral offset. Clin Orthop Relat Res 467(11):2895–2900. https://doi.org/10.1007/s11999-009-0845-3
Sakalkale DP, Sharkey PF, Eng K, Hozack WJ, Rothman RH (2001) Effect of femoral component offset on polyethylene wear in total hip arthroplasty. Clin Orthop Relat Res 388:125–134
Bicanic G, Delimar D, Delimar M, Pecina M (2009) Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia. Int Orthop 33(2):397–402. https://doi.org/10.1007/s00264-008-0683-z
Ait Si Selmi T, Lustig S, Dojcinovic S, Neyret P (2006) Morbidity and reliability of total hip implants positioning using the posterior minimally invasive approach: a consecutive series of 100 cases. Rev Chir Orthop Reparatrice Appar Mot 92(8):752–759
Batailler C, Fary C, Batailler P, Servien E, Neyret P, Lustig S (2017) Total hip arthroplasty using direct anterior approach and dual mobility cup: safe and efficient strategy against post-operative dislocation. Int Orthop 41(3):499–506. https://doi.org/10.1007/s00264-016-3333-x
Murphy CG, Bonnin MP, Desbiolles AH, Carrillon Y, Asmall yi USST (2016) Varus will have varus; a radiological study to assess and predict varus stem placement in uncemented femoral stems. Hip Int 26(6):554–560. https://doi.org/10.5301/hipint.5000412
Migliorini F, Biagini M, Rath B, Meisen N, Tingart M, Eschweiler J (2018) Total hip arthroplasty: minimally invasive surgery or not?. Int Orthop, Meta-analysis of clinical trials. https://doi.org/10.1007/s00264-018-4124-3
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Migliorini, F., Eschweiler, J., Trivellas, A. et al. Implant positioning among the surgical approaches for total hip arthroplasty: a Bayesian network meta-analysis. Arch Orthop Trauma Surg 140, 1115–1124 (2020). https://doi.org/10.1007/s00402-020-03448-w
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DOI: https://doi.org/10.1007/s00402-020-03448-w