Risk Factors and Predictors for Functional Outcome and Complication Rate in Total Hip Arthroplasty through Minimally Invasive and Conventional Approaches: A Systematic Review and Meta-Regression Analysis of 41 Randomized Controlled Trials

Nikolai Ramadanov; Marko Ostojic; Philip Lazaru; Kuiliang Liu; Robert Hable; Polina Marinova-Kichikova; Dobromir Dimitrov; Roland Becker

doi:10.3390/jcm12185895

Risk Factors and Predictors for Functional Outcome and Complication Rate in Total Hip Arthroplasty through Minimally Invasive and Conventional Approaches: A Systematic Review and Meta-Regression Analysis of 41 Randomized Controlled Trials

J Clin Med. 2023 Sep 11;12(18):5895. doi: 10.3390/jcm12185895.

Authors

Nikolai Ramadanov¹, Marko Ostojic², Philip Lazaru³, Kuiliang Liu⁴, Robert Hable⁵, Polina Marinova-Kichikova⁶, Dobromir Dimitrov⁷, Roland Becker¹

Affiliations

¹ Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, 14770 Brandenburg an der Havel, Germany.
² Department of Orthopedics, University Hospital Mostar, 88000 Mostar, Bosnia and Herzegovina.
³ Department of General and Visceral Surgery, Minimally Invasive Surgery and Coloproctology, St. Marien Hospital, 12249 Berlin, Germany.
⁴ Department for Orthopaedics and Trauma Surgery, Siloah St. Trudpert Hospital, 75179 Pforzheim, Germany.
⁵ Faculty of Applied Computer Science, Deggendorf Institute of Technology, 94469 Deggendorf, Germany.
⁶ Department of Surgical Propaedeutics, Faculty of Medicine, Medical University of Pleven, 5800 Pleven, Bulgaria.
⁷ Department of Surgical Diseases, Faculty of Medicine, Medical University of Pleven, 5800 Pleven, Bulgaria.

Abstract

Objective: To investigate and identify risk factors and predictors for the difference in functional outcome and complications between total hip arthroplasty (THA) through minimally invasive and conventional approaches, using a meta-regression analysis of randomized controlled trials (RCTs).

Methods: A systematic review of the literature up to 31 July 2022 was performed. A meta-regression was conducted based on a random effects meta-analysis using the Hartung-Knapp-Sidik-Jonkman method.

Results: A total of 41 RCTs with 3607 patients were found. The following predictors of HHS ≥ 6 months postoperatively were identified: patient age (predictor estimate = 0.14; p < 0.01), avascular necrosis of the femoral head (predictor estimate = -0.03; p = 0.04); incision length (predictor estimate = -0.82; p < 0.01). The following predictors of complication rate were identified: osteoarthritis (predictor estimate = 0.02; p = 0.02); femoral neck fracture (predictor estimate = -0.02; p = 0.02); SuperPATH (predictor estimate = -1.72; p < 0.01).

Conclusions: Patient age, avascular necrosis of the femoral head, and incision length were identified as predictors of the effect size of the HHS ≥ 6 months postoperatively; and osteoarthritis, femoral neck fracture, and SuperPATH as predictors of the effect size of the complication rate. Based on these findings, we recommend that more frequent use of minimally invasive THA in elderly patients should be considered.

Level of evidence i: a systematic review of all relevant randomized controlled trials. Registered in PROSPERO on 10 August 2022 (CRD42022350287).

Keywords: conventional approach; meta-regression; minimally invasive; total hip arthroplasty.

Publication types

Review

Grants and funding

Funded by the Brandenburg Medical School publication fund supported by the German Research Foundation and the Ministry of Science, Research and Cultural Affairs of the State of Brandenburg.