Direct anterior approach vs. SuperPATH vs. conventional approaches in total hip replacement: A network meta-analysis of randomized controlled trials

Nikolai Ramadanov; Simon Bueschges; Kuiliang Liu; Philip Lazaru; Ivan Marintschev

doi:10.1016/j.otsr.2021.103058

Direct anterior approach vs. SuperPATH vs. conventional approaches in total hip replacement: A network meta-analysis of randomized controlled trials

Orthop Traumatol Surg Res. 2021 Dec;107(8):103058. doi: 10.1016/j.otsr.2021.103058. Epub 2021 Sep 15.

Authors

Nikolai Ramadanov¹, Simon Bueschges², Kuiliang Liu³, Philip Lazaru⁴, Ivan Marintschev⁵

Affiliations

¹ Department of Emergency Medicine, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, 07747 Jena, Germany. Electronic address: nikolai.ramadanov@gmail.com.
² Faculty of Medicine, Department of Statistics, University of Salamanca, Calle Espejo 2, 37007 Salamanca, Spain.
³ Department for Orthopaedics and Trauma Surgery, Siloah St. Trudpert Hospital, Wilferdinger Str. 67, 75179 Pforzheim, Germany.
⁴ Center for Surgery, Evangelical Hospital Ludwigsfelde-Teltow, Albert-Schweizer-Str. 40-44, 14974 Ludwigsfelde, Germany.
⁵ Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, 07747 Jena, Germany.

PMID: 34536596
DOI: 10.1016/j.otsr.2021.103058

Abstract

Background: Two minimally invasive approaches showed some advantages in outcomes compared to conventional approaches (CAs) - the direct anterior approach (DAA) and the supercapsular percutaneously assisted approach in THA (SuperPATH). To the best of our knowledge, these three approaches have never been ranked in a network meta-analysis (NMA) before. Therefore, we conducted a systematic review and NMA of randomized controlled trials comparing short-term outcomes of DAA, SuperPATH and CAs in total hip joint arthroplasty (THA), using CAs as common comparator.

Methods: A systematic literature search up to February 2021 was performed to identify randomized controlled trials (RCTs) comparing DAA with CAs and SuperPATH with CAs in THA. We measured surgical, functional and radiological outcomes. A NMA, using frequentist methods was performed to assess treatment effects between DAA, SuperPATH and CAs. Information was borrowed from the above-mentioned RCTs, using the CA group as a common comparator.

Results: A total of 24 RCTs involving 2,074 patients met the inclusion criteria, six trials with a level I evidence, 18 trials with level II evidence. SuperPATH reduced operation time (fixed effects model: MD=8.1, 95% CI: 5.7 to 10.4), incision length (fixed effects model: MD=2.7, 95%CI: 2.5 to 2.9; random effects model: MD=4.1, 95%CI: 0.6 to 7.6), intraoperative blood loss (fixed effects model: MD=157, 95%CI: 139.2 to 174.2; random effects model: MD=129, 95%CI: 11.5 to 245.7) and early pain intensity (VAS 1 day postoperatively with a fixed effects model: MD=0.8, 95%CI: 0.4 to 1.2) compared to DAA. The two approaches did not differ in functional outcome and in acetabular cup inclination positioning.

Conclusions: Our overall findings suggest that short-term outcomes of THA through SuperPATH were superior to DAA and CAs and that short-term outcomes of THA through DAA were superior to CAs.

Level of evidence: II; systematic review with level I studies and level II studies.

Keywords: Approach; Direct anterior approach; Meta-analysis; Network; SuperPATH; THA.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Acetabulum / surgery
Arthroplasty, Replacement, Hip* / methods
Humans
Network Meta-Analysis
Randomized Controlled Trials as Topic
Treatment Outcome