Evidence map›Paper›PMID 34410479›Full record

SynthesisArchives of orthopaedic and trauma surgery2022

Short-term outcomes vary by surgical approach in total hip arthroplasty: a network meta-analysis.

Aaron Gazendam, Anthony Bozzo, Seper Ekhtiari, Colin Kruse, Nancy Hiasat, Daniel Tushinski, Mohit Bhandari

Abstract readSystematic ReviewNetwork Meta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Archives of orthopaedic and trauma surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 3 syntheses or guidelines pooled it.

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  14. Causes and predictors of failed same-day home discharge following primary hip and knee total joint arthroplasty: a Canadian perspective.Hip international : the journal of clinical and experimental research on hip pathology and therapy · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Aaron GazendamDivision of Orthopaedic Surgery, Department of Surgery, McMaster University, St. Joseph's Hospital, Room G522, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada. aaron.gazendam@gmail.com.ORCID http://orcid.org/0000-0002-2615-4919
Anthony BozzoDivision of Orthopaedic Surgery, Department of Surgery, McMaster University, St. Joseph's Hospital, Room G522, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
Seper EkhtiariDivision of Orthopaedic Surgery, Department of Surgery, McMaster University, St. Joseph's Hospital, Room G522, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
Colin KruseMcMaster Medical School, McMaster University, Hamilton, ON, Canada.
Nancy HiasatNear East University Hospital, North Nicosia, Turkey.
Daniel TushinskiDivision of Orthopaedic Surgery, Department of Surgery, McMaster University, St. Joseph's Hospital, Room G522, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
Mohit BhandariDivision of Orthopaedic Surgery, Department of Surgery, McMaster University, St. Joseph's Hospital, Room G522, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe direct anterior approach (DAA) has increased in popularity in recent years. Proponents cite its muscle-sparing approach and purported reduction in pain and improvement in function when compared to the traditional surgical approaches. There remains controversy surrounding the validity of these claims. The objective of this study was to compare the common total hip surgical approaches in terms of pain scores, functional outcomes, opioid use and complications within the first 12 weeks postoperatively.

methodsA network meta-analysis of randomized controlled trials (RCT) comparing postoperative outcomes of different surgical approaches in primary THA up to 12 weeks was performed. PubMed, MEDLINE, Embase, Web of Science and SCOPUS were systematically searched from inception to May 2020. Outcomes included pain scores, functional outcome scores, length of stay (LOS), complications and opioid consumption.

resultsTwenty-five RCTs (n = 2339) were included. The DAA demonstrated statistically significant improvement in Harris Hip Scores at 6 weeks when compared to the posterior and direct lateral approaches. The DAA reduced pain scores on postoperative day 2 and at 2 weeks compared to the direct lateral approach. The anterolateral approach was found to have a significantly shorter LOS compared to the other major surgical approaches. The differences in functional outcomes or pain scores did not surpass conventional cutoffs for a minimal clinically important difference.

conclusionThe DAA led to functional improvements at 6 weeks compared to the posterior and direct lateral approaches and reduced postoperative pain compared to the direct lateral approach. However, these improvements failed to reach clinical significance. All major surgical approaches led to large improvements in function by 12 weeks with relatively low complication rates. Whether a short-term statistically significant improvement in function is sufficiently patient important to recommend DAA as a standard remains uncertain.

Indexed as

Arthroplasty, Replacement, HipAnalgesics, OpioidHumansLength of StayPostoperative PainTreatment OutcomeAnalgesics, OpioidDirect anterior approachShort-term outcomesSurgical approachTotal hip arthroplasty

Identifiers

PMID34410479

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.