Direct lateral THA yielded lowest hip score improvement compared with other approaches
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According to a systematic review of total hip arthroplasty approaches, the direct lateral approach yielded the lowest improvement in hip score compared with other approaches.
Lei Yan, MD, and colleagues used PubMed, EMBASE and Cochrane databases to review 63 randomized control trials that compared outcomes of eight surgical approaches to THA in 4,859 patients (median age of 64 years). The approaches included: the posterior approach (PA), two-incision approach, direct anterior approach (DAA), direct lateral approach (DLA), minimally invasive direct lateral approach (MIS-DLA), minimally invasive anterolateral approach (MIS-ALA), minimally invasive posterior approach (MIS-PA) and supercapsular percutaneously assisted approach.
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According to the study, outcome measures included Harris hip scores, VAS pain scores, quality of life scores, hospitalization time, OR time, blood loss, cup abduction angle and cup anteversion angle.
Yan and colleagues found that compared the DLA, the DAA (mean difference [MD] = 4.04), MIS-ALA (MD = 3), MIS-DLA (MD = 3.37), MIS-PA (MD = 4.46), PA (MD = 4.37) and SuperPath approach (MD = 5) were all associated with greater improvements in hip score. The DLA was also associated with a lower decrease in pain score compared with the SuperPath approach (MD = 1.16) and the MIS-DLA (MD = 0.9). While complication rates were similar between all approaches, the researchers noted the PA was associated with shorter OR times and the DLA was associated with increased blood loss.
“These findings will aid clinicians in balancing the risks and benefits of available approaches for primary THA and provide key evidence for producing recommendations for clinical practice,” the researchers wrote in the study.
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