Minimally Invasive Versus Conventional Approaches in Total Hip Arthroplasty: A Systematic Review and Meta-Analysis of 47 Randomized Controlled Trials

IF 2.9

Prosthesis Pub Date : 2023-09-16 DOI:10.3390/prosthesis5030067

Nikolai Ramadanov, Polina Marinova-Kichikova, Robert Hable, Dobromir Dimitrov

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引用次数: 0

Abstract

Background: Recent meta-analyses have shown indifferent results between minimally invasive (MI) and conventional approach (CA) total hip arthroplasty (THA), not including the superior MI approach SuperPATH. The aim was to compare the surgical, functional and radiological outcomes and postoperative complications of MI THA, including SuperPATH, with CA THA in patients with hip disease or femoral neck fracture. Methods: PubMed, CNKI, The Cochrane Library, clinical trials, CINAHL and Embase were searched for randomized controlled trials (RCTs) comparing MI THA and CA THA up to 31 July 2023. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated for continuous outcomes and odds ratios (ORs) with 95% CIs were calculated for dichotomous outcomes using a common effect/random effects model. The random effects model was used to present the results. Heterogeneity was assessed using the Cochrane Q test and the Higgins I2 test. Results: A total of 47 RCTs with 4086 THAs in 4063 patients were included in our meta-analysis. MI THA showed better results than CA THA in 8 of 18 outcome parameters studied. MI THA showed a higher Harris Hip Score (HHS) than CA THA at 0–1.5, 3, 6 and ≥12 months postoperatively (p < 0.01; p = 0.02; p = 0.01; p = 0.01). MI THA showed an indifferent overall postoperative complication risk compared to CA THA (p = 0.61). Acetabular positioning angles were within the safe zone in all approaches. Conclusions: The results of the meta-analysis suggest that MI THA has several advantages over CA THA in terms of short-term surgical and functional outcomes, with equal postoperative complication rates. We cannot recommend a change in surgical approach based on our results, as the differences between the investigated approaches did not reach minimal clinically important differences. Level of evidence I: a systematic review of all relevant randomized controlled trials.

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微创与传统方法在全髋关节置换术中的比较:47个随机对照试验的系统回顾和荟萃分析

背景:最近的荟萃分析显示微创(MI)和传统入路(CA)全髋关节置换术(THA)的结果无关，不包括高级MI入路SuperPATH。目的是比较包括SuperPATH在内的MI THA与CA THA在髋关节疾病或股骨颈骨折患者中的手术、功能和放射预后以及术后并发症。方法:检索PubMed、CNKI、Cochrane Library、临床试验、CINAHL和Embase，检索截至2023年7月31日比较MI THA和CA THA的随机对照试验(RCTs)。使用共同效应/随机效应模型计算连续结局的95%置信区间(ci)的平均差异(MDs)，计算二分结局95% ci的比值比(ORs)。采用随机效应模型来表示结果。采用Cochrane Q检验和Higgins I2检验评估异质性。结果:我们的荟萃分析共纳入了47项随机对照试验，涉及4086例THAs，涉及4063例患者。在研究的18个结果参数中，MI THA的8个结果优于CA THA。MI THA术后0 ~ 1.5个月、3个月、6个月和≥12个月Harris髋关节评分(HHS)高于CA THA (p <0.01;P = 0.02;P = 0.01;P = 0.01)。与CA THA相比，MI THA的总体术后并发症风险无差异(p = 0.61)。所有入路髋臼定位角度均在安全范围内。结论:荟萃分析的结果表明，在短期手术和功能结果方面，MI THA优于CA THA，术后并发症发生率相同。根据我们的结果，我们不能建议改变手术入路，因为所研究的入路之间的差异没有达到最小的临床重要差异。证据等级I:对所有相关随机对照试验进行系统评价。

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Prosthesis

CiteScore

4.80

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0.00%

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