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Disadvantage during Perioperative Period of Total Hip Arthroplasty Using the Direct Anterior Approach: a Network Meta-Analysis

Journal of Korean Medical Science 2020년 35권 18호 p.111 ~ 111
차용한 ( Cha Yong-Han ) - Eulji University Hospital Department of Orthopaedic Surgery

유준일 ( Yoo Jun-Il ) - Gyeongsang National University Hospital Department of Orthopaedic Surgery
김정택 ( Kim Jung-Taek ) - Ajou University School of Medicine Ajou University Medical Center Department of Orthopedic Surgery
박찬호 ( Park Chan-Ho ) - Yeungnam University Medical Center Department of Orthopaedic Surgery
최원식 ( Choy Won-Sik ) - Eulji University Hospital Department of Orthopaedic Surgery
하용찬 ( Ha Yong-Chan ) - Chung-Ang University College of Medicine Department of Orthopaedic Surgery
구경회 ( Koo Kyung-Hoi ) - Seoul National University Bundang Hospital Department of Orthopaedic Surgery

Abstract


Background: The purpose of this study was to analyze complications of complete hip arthroplasty through systematic review and network meta-analysis of comparative studies of direct anterior approach (DAA), anterolateral approach (LA), and posterolateral approach (PA).

Methods: Prospective randomized controlled trials (RCTs) or quasi-experimental designs evaluating clinical outcomes of DAA, LA, and PA for complete hip arthroplasty are valid if they meet the following criteria: 1) Comparison of clinical outcomes between the three methods for main complete hip arthroplasty (total hip arthroplasty, THA); 2) Compared at least one of the following outcomes: blood loss, operating time, and transfusion volume; 3) Sufficient data were available to extract and pool, i.e., mean reported, standard deviation and number of subjects. A network meta-analysis was used to determine the results of treatment across various surgical approaches. Indirect comparisons between the two surgical approaches was made by borrowing details from the standard comparator (i.e., the posterior approach).

Results: Eight prospective RCTs were included in the meta-analysis of the network. The operation time of the LA was longer than that of PA (standardized mean difference [SMD], 0.96; 95% confidence interval [CI], 0.74?1.18; P < 0.001). DAA also had significantly longer operation time than PA (SMD, 0.45; 95% CI, 0.24?0.66; P < 0.001). However, blood loss of the DAA was the highest compared to other approaches (SMD, 0.60; 95% CI, 0.39?0.82; P = 0.002).

Conclusion: When performing THA with DAA, we should pay attention to increased operation time and blood loss.

키워드

Total Hip Arthroplasty; Direct Anterior; Anterolateral; Harding; Gait Analysis
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