Which approach of total hip arthroplasty is the best efficacy and least complication?  

作　　者：Lertkong Nitiwarangkul Natthapong Hongku Oraluck Pattanaprateep Sasivimol Rattanasiri Patarawan Woratanarat Ammarin Thakkinstian 

机构地区：[1]Clinical Epidemiology and Biostatistics,Faculty of Medicine Ramathibodi Hospital,Mahidol University,Bangkok 10400,Thailand [2]Orthopaedics Surgery,Police General Hospital,Bangkok 10330,Thailand [3]Department of Orthopaedics,Faculty of Medicine Vajira Hospital,Navamindrahiraj University,Bangkok 10300,Thailand [4]Department of Orthopaedics,Faculty of Medicine Ramathibodi Hospital,Mahidol University,Bangkok 10400,Thailand

出　　处：《World Journal of Orthopedics》2024年第1期73-93,共21页世界骨科杂志（英文版）

摘　　要：BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications of hip approaches remains inconclusive.This study conducted an umbrella review to systematically appraise previous meta-analysis(MAs)including conventional posterior approach(PA),and minimally invasive surgeries as the lateral approach(LA),direct anterior approach(DAA),2-incisions method,mini-lateral approach and the newest technique direct superior approach(DSA)or supercapsular percutaneouslyassisted total hip(SuperPath).AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials(RCTs).METHODS MAs were identified from MEDLINE and Scopus from inception until 2023.RCTs were then updated from the latest MA to September 2023.This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score(HHS),dislocation,intra-operative fracture,wound compliData were independently selected,extracted and assessed by two reviewers.Network MA and cluster rank and surface under the cumulative ranking curve(SUCRA)were estimated for treatment efficacy and safety.RESULTS Finally,twenty-eight MAs(40 RCTs),and 13 RCTs were retrieved.In total 47 RCTs were included for reanalysis.The results of corrected covered area showed high degree(13.80%).Among 47 RCTs,most of the studies were low risk of bias in part of random process and outcome reporting,while other domains were medium to high risk of bias.DAA significantly provided higher HHS at three months than PA[pooled unstandardized mean difference(USMD):3.49,95%confidence interval(CI):0.98,6.00 with SUCRA:85.9],followed by DSA/SuperPath(USMD:1.57,95%CI:-1.55,4.69 with SUCRA:57.6).All approaches had indifferent dislocation and intraoperative fracture rates.SUCRA comparing early functional outcome and composite complications(dislocation,intra-operative fracture,

关 键 词：Total hip arthroplasty Total hip replacement APPROACH Supercapsular percutaneously-assisted total hip Harris Hip Score Intra-operative fracture 

分 类 号：R687.4[医药卫生—骨科学]