1
|
Ramadanov N, Voss M, Diallo RM, Lettner J, Hakam HT, Prill R, Becker R, Hable R. Do Meta-Analyses of Total Hip Arthroplasty Produce Reliable Results? A Systematic Review and Meta-Epidemiological Study of Statistical Methods. Orthop Surg 2025. [PMID: 40425483 DOI: 10.1111/os.70077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2025] [Revised: 03/26/2025] [Accepted: 04/28/2025] [Indexed: 05/29/2025] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is a highly successful orthopedic procedure, with numerous meta-analyses published to optimize its outcomes. However, the reliability of their results and conclusions depends heavily on the use of appropriate statistical methods. Therefore, the aim was to test the reliability of statistical methods in meta-analyses of THA by examining the degree of heterogeneity, the effect of different between-study variance estimators, and the equality of sample size of pooled primary studies. METHODS The literature was systematically searched in PubMed from January 1, 2022, to December 31, 2023, for meta-analyses on THA. The quality of the meta-analyses was assessed using the revised Measurement Tool to Assess Systematic Reviews (AMSTAR 2). All meta-analyses were recalculated using eight different heterogeneity estimators. The following indicators were considered: inequality of patient numbers, proportion of random-effects and fixed-effects models, heterogeneity with I2 value, ratio of effect sizes (RES), ratio of confidence interval width (RCIW), and the number of significant results. Mixed linear regression was then used to analyze whether the effect sizes and CIW were significantly different using different heterogeneity estimators. Finally, all examined meta-analyses were recalculated using the eight heterogeneity estimators and the Hartung-Knapp (HK) adjustment. RESULTS Of the 24 meta-analyses examined, 15 reported an outcome using a mean difference and 20 reported an outcome using an odds ratio. The quality assessment identified 10 meta-analyses of high quality, 7 of moderate quality, 4 of low quality, and 3 of critically low quality. The significance of the examined meta-analyses varied considerably depending on the heterogeneity estimators used. In particular, the DerSimonian and Laird and Hunter-Schmidt heterogeneity estimators tended to produce false-positive results. The meta-analyses examined generally did not use HK adjustment. This effect is amplified when combined with the weak DerSimonian and Laird heterogeneity estimator, which were used in almost all examined meta-analyses. CONCLUSION Without HK adjustment, the results depend strongly on the heterogeneity estimator chosen and there is a risk of false positives, especially for the widely used DerSimonian and Laird heterogeneity estimator. For HK adjustment, the choice of heterogeneity estimator seems to play a less important role. We recommend the use of more reliable heterogeneity estimators as well as the HK adjustment as a measure to improve the statistical methodology of meta-analyses. This study highlights the critical need for improved statistical rigor in meta-analyses of THA, ensuring more reliable evidence for clinical decision-making and guideline development.
Collapse
Affiliation(s)
- Nikolai Ramadanov
- Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, Brandenburg an der Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Maximilian Voss
- Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, Brandenburg an der Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Radharani Michelle Diallo
- Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, Brandenburg an der Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Jonathan Lettner
- Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, Brandenburg an der Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Hassan Tarek Hakam
- Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, Brandenburg an der Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Robert Prill
- Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, Brandenburg an der Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Roland Becker
- Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, Brandenburg an der Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Robert Hable
- Faculty of Applied Computer Science, Deggendorf Institute of Technology, Deggendorf, Germany
| |
Collapse
|
2
|
Huang L, Deng S, Fu D, Yang F. SuperPATH versus traditional hip replacement in efficacy and safety: an updated systematic review and meta-analysis. BMC Musculoskelet Disord 2025; 26:248. [PMID: 40075343 PMCID: PMC11899374 DOI: 10.1186/s12891-025-08471-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Accepted: 02/25/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND Hip replacement is a popular orthopedic surgery. The methods include SuperPATH and traditional hip replacement. The efficacy and safety of SuperPATH vs. traditional hip replacement might be an intriguing topic. METHODS The SuperPATH vs. traditional hip replacement comparison for the operation characteristics, hospitalization duration, postoperative pain and hip scores were set for the current systematic review and meta-analysis, which can help us determine the differences in the operation characteristics, hospitalization duration, postoperative pain severity and postoperative hip function between the 2 groups. Only randomized controlled trials (RCT) were eligible and 9 RCTs (299 patients with the superPATH, and 379 patients with traditional hip replacement) were enrolled. We focused on the operation characteristics, hospitalization duration, pain, and hip function after orthopedic surgery. RESULTS The meta-analytic results showed that SuperPATH might be associated with a significantly shorter incision length and hospitalization duration. In addition, the postoperative pain severity was lower and the postoperative hip function was better in the SuperPATH group when compared to traditional hip replacement. CONCLUSIONS The SuperPATH might be beneficial for patients with hip replacement surgery when compared to the traditional hip replacement from the perspective of incision length, hospitalization, pain severity, and hip function. Further RCT studies with a more homogeneous study design and a greater sample size might be warranted in the future.
Collapse
Affiliation(s)
- Ling Huang
- Center for Joint Surgery, Intelligent Manufacturing and Rehabilitation Engineering Center, The First Affiliated Hospital of Army Medical University, Chongqing, 400038, China
- Chongqing Municipal Science and Technology Bureau Key Laboratory of Precision Medicine in Joint Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, 400038, China
- Chongqing Municipal Education Commission Key Laboratory of Joint Biology, Chongqing, China
| | - Shu Deng
- Center for Joint Surgery, Intelligent Manufacturing and Rehabilitation Engineering Center, The First Affiliated Hospital of Army Medical University, Chongqing, 400038, China
- Chongqing Municipal Science and Technology Bureau Key Laboratory of Precision Medicine in Joint Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, 400038, China
- Chongqing Municipal Education Commission Key Laboratory of Joint Biology, Chongqing, China
| | - Dejie Fu
- Center for Joint Surgery, Intelligent Manufacturing and Rehabilitation Engineering Center, The First Affiliated Hospital of Army Medical University, Chongqing, 400038, China
- Chongqing Municipal Science and Technology Bureau Key Laboratory of Precision Medicine in Joint Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, 400038, China
- Chongqing Municipal Education Commission Key Laboratory of Joint Biology, Chongqing, China
| | - Feng Yang
- Gastroenterrology Department, The First Hospital Affiliated to Army Medical University, Chongqing, 400038, China.
| |
Collapse
|
3
|
Di Martino A, Keating C, Butsick MJ, Platano D, Berti L, Hunter LN, Faldini C. Enhancing recovery: surgical techniques and rehabilitation strategies after direct anterior hip arthroplasty. J Orthop Traumatol 2024; 25:45. [PMID: 39349698 PMCID: PMC11442739 DOI: 10.1186/s10195-024-00786-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 08/15/2024] [Indexed: 10/04/2024] Open
Abstract
Total hip arthroplasty (THA) is a common surgical procedure for hip joint pathologies, with the direct anterior approach (DAA) gaining popularity due to potential benefits in postoperative recovery. This review aims to provide a comprehensive analysis of rehabilitation strategies following DAA THA, focusing on surgical techniques, postoperative care, and outcomes. The evolution of the DAA to THA is discussed, highlighting historical advancements and comparisons with other surgical approaches. Surgical techniques and considerations specific to the DAA are detailed, including outcomes and complications compared to alternative approaches. The role of the surgical technique in influencing postoperative rehabilitation is explored, emphasizing the importance of optimizing surgical procedures for enhanced recovery. Postoperative care and rehabilitation models following DAA THA are examined, with a focus on the impacts of different rehabilitation protocols on patient outcomes. The review underscores the significance of tailored rehabilitation programs in promoting optimal recovery and patient satisfaction. Current evidence from recent studies, meta-analyses, and clinical trials is critically analyzed to provide insights into the effectiveness of postoperative rehabilitation strategies. The review identifies gaps in the existing literature and proposes recommendations for future research to improve rehabilitation protocols and enhance outcomes. In conclusion, this review highlights the importance of postoperative rehabilitation in the context of DAA THA. By synthesizing historical perspectives, current evidence, and future directions, the review offers a comprehensive understanding of rehabilitation strategies following DAA THA. The findings underscore the need for personalized rehabilitation programs and ongoing research to optimize postoperative recovery and improve outcomes in the field of THA.
Collapse
Affiliation(s)
- Alberto Di Martino
- 1st Orthopedic and Traumatology Clinic, IRCCS Rizzoli Orthopedic Institute, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy.
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States.
| | - Christopher Keating
- Department of Physical Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, United States
| | - Michael J Butsick
- Department of Physical Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, United States
| | - Daniela Platano
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lisa Berti
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Louis N Hunter
- Department of Physical Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, United States
- Jefferson College of Health Professions, Thomas Jefferson University, Philadelphia, PA, United States
| | - Cesare Faldini
- 1st Orthopedic and Traumatology Clinic, IRCCS Rizzoli Orthopedic Institute, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| |
Collapse
|
4
|
Lee A, Arthur J, Najdawi J, Durst CR, Rajaee SS, Spitzer AI. No Decrease in Early Survivorship of Dual Mobility Implants in Primary Total Hip Arthroplasty. Arthroplast Today 2024; 28:101452. [PMID: 39071094 PMCID: PMC11282969 DOI: 10.1016/j.artd.2024.101452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/06/2024] [Accepted: 06/03/2024] [Indexed: 07/30/2024] Open
Abstract
Background Dual mobility (DM) implants in primary total hip arthroplasty (THA) have gained recent popularity; however, safety concerns persist. The purpose of this study was twofold: 1) assess trends in DM implant adoption; and 2) evaluate the impact of modular DM implants on dislocation and all-cause revision rates at short-term follow-up. Methods This retrospective study identified patients in our institutional arthroplasty database who underwent primary posterior approach THA for degenerative conditions from November 2013 to December 2020. Patients undergoing primary THA for fracture were excluded. Patients were divided into two cohorts: modular DM and non-DM implants. Annual DM utilization and dislocation rates were recorded. Patient records were reviewed to determine implant selection and identify indications for dislocations and reoperations. Results Institutional adoption was rapid, increasing from 3.4% in 2013 to 47.1% in 2020. Of the 4548 primary THA cases from 2013 to 2020, 2859 (62.9%) had minimum one-year follow-up data for inclusion. There were 724 (25.3%) with DM implants and 2135 (74.7%) with non-DM implants. The DM group had a significantly lower dislocation rate (0.14% vs 0.84%, P = .04), with similar all-cause revision rates (2.49% vs 2.72%, P = .74) at one-year follow-up. No cases of DM-specific complications (metallosis or intraprosthetic dislocations) were noted. Conclusions From 2013 to 2020, DM implant utilization in primary THA steadily increased. Use of modular DM implants is associated with a decreased dislocation rate without compromised survivorship at one-year follow-up when compared to non-DM implants. No instances of modular DM-specific complications were identified; however, longer-term surveillance is necessary to verify these findings. Level of Evidence Prognostic Level III.
Collapse
Affiliation(s)
- Anderson Lee
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jaymeson Arthur
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jawad Najdawi
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Caleb R. Durst
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean S. Rajaee
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew I. Spitzer
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
5
|
Ramadanov N, Voss M, Jóźwiak K, Prill R, Hakam HT, Salzmann M, Dimitrov D, Becker R. Indirect comparison in network meta-analysis between SuperPATH, direct anterior and conventional approach hemiarthroplasty in patients with femoral neck fracture. Medicine (Baltimore) 2024; 103:e39068. [PMID: 39058802 PMCID: PMC11272366 DOI: 10.1097/md.0000000000039068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The aim of the study was to compare the short-term outcome of SuperPATH, direct anterior (DAA) and conventional approach (CA) hemiarthroplasty (HA) in patients with femoral neck fractures using a network meta-analysis. METHODS PubMed, China National Knowledge Infrastructure, Epistemonikos, and Embase were searched until May 31, 2024. In a network meta-analysis, mean differences with 95% confidence intervals were calculated using the Hartung-Knapp-Sidik-Jonkman method and a fixed/random effects model for continuous outcomes, and odds ratios with 95% confidence intervals were calculated using the Mantel-Haenszel method and a fixed/random effects model for dichotomous outcomes. RESULTS The literature search identified a total of 9 randomized controlled trials on SuperPATH with 762 patients and 8 randomized controlled trials on DAA with 641 patients. In the overall ranking, SuperPATH was placed first, DAA second and CA third. SuperPATH HA was best in 7, second best in 2 and third best in 1 of the 10 outcome parameters. DAA HA was best in 2 and second best in 8 of the 10 outcome parameters. CA HA was best in 1 and third best in 9 of the 10 outcome parameters. In the indirect comparison between SuperPATH HA and DAA HA, SuperPATH HA had a 1.36 point lower visual analog scale at 2 to 7 days postoperatively and a 0.17 lower overall complication rate compared to DAA. CONCLUSION For the treatment of patients with femoral neck fractures, SuperPATH HA ranked first, DAA HA ranked second and CA HA ranked third. Based on the results, we recommend that trauma surgeons increase their use of minimally invasive hip HA techniques. It should be noted that SuperPATH HA had a significantly lower overall complication rate compared to DAA HA when the minimally invasive technique was chosen.
Collapse
Affiliation(s)
- Nikolai Ramadanov
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | - Maximilian Voss
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | - Hassan Tarek Hakam
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | - Mikhail Salzmann
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| | - Dobromir Dimitrov
- Department of Surgical Diseases, Faculty of Medicine, Medical University of Pleven, Pleven, Bulgaria
| | - Roland Becker
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg/Havel, Germany
| |
Collapse
|
6
|
Nitiwarangkul L, Hongku N, Pattanaprateep O, Rattanasiri S, Woratanarat P, Thakkinstian A. Which approach of total hip arthroplasty is the best efficacy and least complication? World J Orthop 2024; 15:73-93. [PMID: 38293261 PMCID: PMC10824060 DOI: 10.5312/wjo.v15.i1.73] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 01/16/2024] Open
Abstract
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 percutaneously-assisted 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 complication, nerve injury, operative time, operative blood loss, length of hospital stay, incision length and VAS pain. Data 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, wound complication, and nerve injury) found DAA was the best approach followed by DSA/SuperPath. CONCLUSION DSA/SuperPath had better earlier functional outcome than PA, but still could not overcome the result of DAA. This technique might be the other preferred option with acceptable complications.
Collapse
Affiliation(s)
- Lertkong Nitiwarangkul
- Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
- Orthopaedics Surgery, Police General Hospital, Bangkok 10330, Thailand
| | - Natthapong Hongku
- Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindrahiraj University, Bangkok 10300, Thailand
| | - Oraluck Pattanaprateep
- Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Sasivimol Rattanasiri
- Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Patarawan Woratanarat
- Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Ammarin Thakkinstian
- Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| |
Collapse
|
7
|
Zhao Y, Sun W, Wang C, Xie X, Feng G. Comparison of clinical outcomes of supercapsular percutaneously-assisted approach total hip arthroplasty versus conventional posterior approach for total hip arthroplasty in adults: a systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:25. [PMID: 38166873 PMCID: PMC10759432 DOI: 10.1186/s12891-023-07126-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE This meta-analysis was aimed to compare the postoperative clinical outcomes between the supercapsular percutaneously assisted total hip (SuperPATH, SP) and conventional posterior/posterolateral approach (PA) for total hip arthroplasty in patients who have failed conservative treatment for hip-related disorders. METHODS PRISMAP guidelines were followed in this systematic review. CNKI, Wanfang, PubMed, Embase, Cochrane, Web of Science databases and the reference list grey literature were searched for studies according to the search strategy. Endnote (version 20) was used to screen the searched studies according to the inclusion and exclusion criterias and extract the data from the eligible studied. RR and 95% CI were used for dichotomous variables and MD and 95% CI were used for continuous variables. All analyses and heterogeneity of outcomes were analysed by Review Manage (version 5.4). Publication bias of included studies was analysed by Stata (version 16.0). RESULTS Thirty-six randomized control studies were included. Compared to PA group, SP group had a shorter incision length, less intraoperative blood loss, a shorter length of hospital stay and do activities earlier. Hip function (HHS) was significantly improved within three months postoperatively. Pain of hip (VAS) was significantly reduced within one month postoperatively. The state of daily living (BI) was significantly improved within three months. Patients' overall health status (SF-36) improved significantly postoperatively. There was no difference in postoperative complications between the two approaches. PA had a shorter operative time and a higher accuracy of prosthesis placement. CONCLUSION The advantages of SuperPATH include accelerated functional recovery and less trauma associated with surgery. However, it required a longer operative time and implantation of the prosthesis was less accurate than that of PA.
Collapse
Affiliation(s)
- Yize Zhao
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wenchen Sun
- Anhui Medical University, Hefei, Anhui, China
| | - Chen Wang
- Anhui Medical University, Hefei, Anhui, China
| | - Xinyi Xie
- Anhui Medical University, Hefei, Anhui, China
| | - Ganjun Feng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
8
|
Ramadanov N, Jóźwiak K, Marinova-Kichikova P, Lazaru P, Dimitrov D. Hemiarthroplasty through SuperPATH versus hemiarthroplasty through conventional approaches in patients with femoral neck fractures: a systematic review and meta-analysis of randomized controlled trials. Sci Rep 2023; 13:22861. [PMID: 38129648 PMCID: PMC10739891 DOI: 10.1038/s41598-023-50206-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
The aim was to conduct a systematic review of literature and meta-analysis of randomized controlled trials (RCTs) comparing short-term outcomes of bipolar hemiarthroplasty (HA) through SuperPATH and bipolar HA through conventional approaches (CAs) in patients with femoral neck fractures. The following PICO question was formulated: In human participants with femoral neck fractures, are the short-term outcomes of SuperPATH HA better than the short-term outcomes of CAs HA? The following databases were searched until 25 August 2023: PubMed, CNKI, CENTRAL of The Cochrane Library, Clinical trials, and Google Scholar. Quality assessment of the RCTs was performed, according to the Cochrane's Risk of Bias 2 tool and the recommendations of the GRADE system. Furthermore, we evaluated publication bias with funnel plots. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated for continuous variables using the Hartung-Knapp-Sidik-Jonkman method and a random effects model. Nine RCTs with overall 762 patients were included in this meta-analysis. All 9 RCTs were rated with a moderate risk of bias. The quality of evidence of the outcome parameters was rated moderate to very low. The funnel plots were overall broadly symmetrical, possibly indicating low to moderate publication bias. SuperPATH had a longer operation time compared to CAs (MD = 21.79, 95% CI 12.57 to 31.02). SuperPATH decreased incision length (MD = - 4.50; 95% CI - 5.80 to - 3.20), intraoperative blood loss (MD = - 103.96, 95% CI - 150.27 to - 55.66), postoperative drainage volume (MD = - 137.30, 95% CI - 178.74 to - 95.86), time to mobilization (MD = - 3.86; 95% CI - 5.96 to - 1.76), pain VAS ≤ 1 week postoperatively (MD = - 1.81; 95% CI - 2.17 to - 1.45), and hospitalization time (MD = - 4.05; 95% CI - 4.96 to - 3.15). SuperPATH improved HHS ≤ 1 week postoperatively (MD = 11.10; 95% CI 1.65 to 20.54) and HHS 3 months postoperatively (MD = 6.33; 95% CI 3.97 to 8.69). There was no difference in pain VAS 1-3 months postoperatively (MD = - 0.08; 95% CI - 0.22 to 0.05) and HHS 6 months postoperatively (MD = 0.44; 95% CI - 0.11 to 1.00). This is the first meta-analysis comparing SuperPATH HA with CAs HA in patients with femoral neck fractures. SuperPATH HA was superior in the early short-term functional outcome (HHS) compared to CAs HA, reaching minimal clinically important differences. Furthermore, SuperPATH HA showed significantly better results in incision length, blood loss, time to mobilization, pain intensity (VAS), and hospitalization time than CAs HA.
Collapse
Affiliation(s)
- Nikolai Ramadanov
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg an der Havel, Neuruppin, Germany.
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.
| | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Polina Marinova-Kichikova
- Department of Surgical Diseases, Faculty of Medicine, Medical University of Pleven, Pleven, Bulgaria
| | - Philip Lazaru
- General and Visceral Surgery, Minimally Invasive Surgery and Coloproctology, St. Marien Hospital, Berlin, Germany
| | - Dobromir Dimitrov
- Department of Surgical Propedeutics, Faculty of Medicine, Medical University of Pleven, Pleven, Bulgaria
| |
Collapse
|
9
|
Borsinger TM, Chandi SK, Puri S, Debbi EM, Blevins JL, Chalmers BP. Total Hip Arthroplasty: An Update on Navigation, Robotics, and Contemporary Advancements. HSS J 2023; 19:478-485. [PMID: 37937097 PMCID: PMC10626925 DOI: 10.1177/15563316231193704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 11/09/2023]
Abstract
While total hip arthroplasty (THA) remains effective for improvement of pain and function in patients with osteoarthritis and avascular necrosis, there remain areas of continued pursuit of excellence, including decreasing rates of dislocation, leg length discrepancy, implant loosening, and infection. This review article covers several bearing surfaces and articulations, computer-assisted navigation and robotic technology, and minimally invasive surgical approaches that have sought to improve such outcomes. Perhaps the most significant improvement to THA implant longevity has been the broad adoption of highly cross-linked polyethylene, with low wear rates. Similarly, navigation and robotic technology has proven to more reproducibly achieve intraoperative component positioning, which has demonstrated clinical benefit with decreased risk of dislocation in a number of studies. Given the projected increase in THA over the coming decades, continued investigation of effective incorporation of technology, soft tissue-sparing approaches, and durable implants is imperative to continued pursuit of improved outcomes in THA.
Collapse
Affiliation(s)
- Tracy M Borsinger
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Sonia K Chandi
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Simarjeet Puri
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Eytan M Debbi
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Jason L Blevins
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Brian P Chalmers
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
10
|
Ramadanov N, Ostojic M, Lazaru P, Liu K, Hable R, Marinova-Kichikova P, Dimitrov D, Becker R. Risk Factors and Predictors for Functional Outcome and Complication Rate in Total Hip Arthroplasty through Minimally Invasive and Conventional Approaches: A Systematic Review and Meta-Regression Analysis of 41 Randomized Controlled Trials. J Clin Med 2023; 12:5895. [PMID: 37762836 PMCID: PMC10531834 DOI: 10.3390/jcm12185895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE To investigate and identify risk factors and predictors for the difference in functional outcome and complications between total hip arthroplasty (THA) through minimally invasive and conventional approaches, using a meta-regression analysis of randomized controlled trials (RCTs). METHODS A systematic review of the literature up to 31 July 2022 was performed. A meta-regression was conducted based on a random effects meta-analysis using the Hartung-Knapp-Sidik-Jonkman method. RESULTS A total of 41 RCTs with 3607 patients were found. The following predictors of HHS ≥ 6 months postoperatively were identified: patient age (predictor estimate = 0.14; p < 0.01), avascular necrosis of the femoral head (predictor estimate = -0.03; p = 0.04); incision length (predictor estimate = -0.82; p < 0.01). The following predictors of complication rate were identified: osteoarthritis (predictor estimate = 0.02; p = 0.02); femoral neck fracture (predictor estimate = -0.02; p = 0.02); SuperPATH (predictor estimate = -1.72; p < 0.01). CONCLUSIONS Patient age, avascular necrosis of the femoral head, and incision length were identified as predictors of the effect size of the HHS ≥ 6 months postoperatively; and osteoarthritis, femoral neck fracture, and SuperPATH as predictors of the effect size of the complication rate. Based on these findings, we recommend that more frequent use of minimally invasive THA in elderly patients should be considered. LEVEL OF EVIDENCE I a systematic review of all relevant randomized controlled trials. Registered in PROSPERO on 10 August 2022 (CRD42022350287).
Collapse
Affiliation(s)
- Nikolai Ramadanov
- Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, 14770 Brandenburg an der Havel, Germany;
| | - Marko Ostojic
- Department of Orthopedics, University Hospital Mostar, 88000 Mostar, Bosnia and Herzegovina;
| | - Philip Lazaru
- Department of General and Visceral Surgery, Minimally Invasive Surgery and Coloproctology, St. Marien Hospital, 12249 Berlin, Germany;
| | - Kuiliang Liu
- Department for Orthopaedics and Trauma Surgery, Siloah St. Trudpert Hospital, 75179 Pforzheim, Germany;
| | - Robert Hable
- Faculty of Applied Computer Science, Deggendorf Institute of Technology, 94469 Deggendorf, Germany;
| | - Polina Marinova-Kichikova
- Department of Surgical Propaedeutics, Faculty of Medicine, Medical University of Pleven, 5800 Pleven, Bulgaria;
| | - Dobromir Dimitrov
- Department of Surgical Diseases, Faculty of Medicine, Medical University of Pleven, 5800 Pleven, Bulgaria;
| | - Roland Becker
- Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, 14770 Brandenburg an der Havel, Germany;
| |
Collapse
|
11
|
Ramadanov N. SuperPATH-Current Status of Evidence and Further Investigations: A Scoping Review and Quality Assessment. J Clin Med 2023; 12:5395. [PMID: 37629436 PMCID: PMC10455631 DOI: 10.3390/jcm12165395] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND SuperPATH is a novel minimally invasive technique for hip replacement that is gaining increasing attention. The aim of this review was to determine the nature, extent, and quality of current research evidence on SuperPATH and to identify areas for further investigations. METHODS A bibliometric search was conducted in PubMed up to 1 August 2023 using the search term "SuperPATH". Data extraction and quality assessment were performed for relevant articles. RESULTS The bibliometric search yielded 51 articles on SuperPATH, 9 of which were meta-analyses, 11 were randomized controlled trials (RCTs), 4 were prospective non-RCTs, 12 were retrospective comparative studies, 11 were case series, and 4 were other article types. Most articles were published between 2015 and 2023, with a steady increase in publications per year. The articles originated from 13 countries, of which China was the most productive (35%). The quality assessment of the meta-analyses showed that 22.2% were of moderate quality, 66.7% were of low quality, and 11.1% were of critically low quality. The quality assessment of the RCTs showed that 36.4% had a low risk of bias (RoB), 27.2% revealed some concerns, and 36.4% had a high RoB. All studies were evaluated for content and taken into account in the formulation of recommendations and conclusions. CONCLUSIONS The SuperPATH evidence varies from low to high quality. There is a steady increase in SuperPATH publications in the English-language literature and an uneven distribution of the article origins, with most articles coming from China. Consistent terminology should be used in the future, referring to the surgical approach as the direct superior approach (DSA) and to the surgical technique as SuperPATH. This review provides further concrete suggestions for future investigations and recommendations to improve study quality.
Collapse
Affiliation(s)
- Nikolai Ramadanov
- Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, 14770 Brandenburg an der Havel, Germany
| |
Collapse
|
12
|
Tanino H. CORR Insights®: The Supercapsular Percutaneously Assisted Total Hip Approach Does Not Provide Any Clinical Advantage Over the Conventional Posterior Approach for THA in a Randomized Clinical Trial. Clin Orthop Relat Res 2023; 481:1126-1128. [PMID: 36441116 PMCID: PMC10194702 DOI: 10.1097/corr.0000000000002508] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/07/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Hiromasa Tanino
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Japan
| |
Collapse
|
13
|
Expression of Concern: Direct anterior approach (DAA) vs. conventional approaches in total hip arthroplasty: A RCT meta-analysis with an overview of related meta-analyses. PLoS One 2023; 18:e0283509. [PMID: 36940220 PMCID: PMC10027205 DOI: 10.1371/journal.pone.0283509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
|
14
|
Shen J, Ji W, Shen Y, He S, Lin Y, Ye Z, Wang B. Comparison of the early clinical efficacy of the SuperPath approach versus the modified Hardinge approach in total hip arthroplasty for femoral neck fractures in elderly patients: a randomized controlled trial. J Orthop Surg Res 2023; 18:215. [PMID: 36935491 PMCID: PMC10024840 DOI: 10.1186/s13018-023-03713-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/14/2023] [Indexed: 03/21/2023] Open
Abstract
PURPOSE To investigate the clinical efficacy and advantages of the SuperPath approach for total hip arthroplasty in the treatment of femoral neck fractures in the elderly population. METHODS From February 2018 to March 2019, 120 patients were randomly divided into two groups with 60 patients each: the SuperPath group and the conventional group. The results evaluated included the general operation situation, serum markers, blood loss, pain score, hip function and prosthesis location analysis. RESULTS There was no demographic difference between the two groups. Compared with the conventional group, the SuperPath group had a shorter operation time (78.4 vs. 93.0 min, p = 0.000), a smaller incision length (5.8 vs. 12.5 cm, p = 0.000), less intraoperative blood loss (121.5 vs. 178.8 ml, p = 0.000), a shorter hospitalization time (8.0 vs. 10.8 days, p = 0.000) and less drainage volume (77.8 vs. 141.2 ml, p = 0.000). The creatine kinase level in the SuperPath group was significantly lower than that in the conventional group, while there was no difference in the C-reactive protein level and erythrocyte sedimentation rate level. The visual analog scale score was lower one month postoperatively, and the Harris hip score was higher three months postoperatively in the SuperPath group (p < 0.05). There was no difference in the cup abduction angle or anteversion angle of the two groups. CONCLUSION We found better clinical efficacy after using the SuperPath approach with less muscle damage, less postoperative pain and better postoperative function than after using the modified Hardinge approach. Trial registration The randomized clinical trial was retrospectively registered at the Chinese Clinical Trial Registry on 31/12/2020 (ChiCTR-2000041583, http://www.chictr.org.cn/showproj.aspx?proj=57008 ).
Collapse
Affiliation(s)
- Jiquan Shen
- Department of Orthopaedics, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, Lishui, 323000, Zhejiang, China
| | - Weiping Ji
- Department of Orthopaedics, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, Lishui, 323000, Zhejiang, China.
| | - Yonghui Shen
- Department of Orthopaedics, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, Lishui, 323000, Zhejiang, China
| | - Shijie He
- Department of Orthopaedics, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, Lishui, 323000, Zhejiang, China
| | - Youbin Lin
- Department of Orthopaedics, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, Lishui, 323000, Zhejiang, China
| | - Zhijun Ye
- Department of Orthopaedics, The People's Hospital of Yunhe, Lishui, 323000, Zhejiang, China
| | - Bo Wang
- Department of Orthopaedics, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, Lishui, 323000, Zhejiang, China.
| |
Collapse
|
15
|
Ramadanov N, Bueschges S, Liu K, Lazaru P, Marintschev I. Direct and indirect comparisons in network meta-analysis of SuperPATH, direct anterior and posterior approaches in total hip arthroplasty. Sci Rep 2022; 12:16778. [PMID: 36202828 PMCID: PMC9537282 DOI: 10.1038/s41598-022-20242-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 09/12/2022] [Indexed: 12/05/2022] Open
Abstract
SuperPATH is a novel approach to the hip joint that needs to be compared to other known surgical approaches. To conduct a network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing short-term outcomes of SuperPATH, direct anterior (DAA), and posterior/ posterolateral approaches (PA) in total hip joint arthroplasty (THA). We performed a systematic review on PubMed, CNKI, Embase, The Cochrane Library, Clinical trials, and Google Scholar up to November 30th, 2021. We assessed treatment effects between SuperPATH, DAA, and PA by performing a frequentist NMA, including a total of 20 RCTs involving 1501 patients. SuperPATH showed a longer operation time (MD = 16.99, 95% CI 4.92 to 29.07), a shorter incision length (MD = −4.71, 95% CI −6.21 to −3.22), a lower intraoperative blood loss (MD = −81.75, 95% CI −114.78 to −48.72), a higher HHS 3, 6 and 12 months postoperatively (MD = 2.59, 95% CI 0.59–4.6; MD = 2.14, 95% CI 0.5–3.77; MD = 0.6, 95% CI 0.03–1.17, respectively) than PA. DAA showed a higher intraoperative blood loss than PA and SuperPATH (MD = 91.87, 95% CI 27.99–155.74; MD = 173.62, 95% CI 101.71–245.53, respectively). No other relevant differences were found. In conclusion, the overall findings suggested that the short-term outcomes of THA through SuperPATH were statistically superior to PA. DAA and PA as well as SuperPATH and DAA showed indifferent results.
Collapse
Affiliation(s)
- Nikolai Ramadanov
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany.
| | - Simon Bueschges
- Faculty of Medicine, Department of Statistics, University of Salamanca, Salamanca, Spain
| | - Kuiliang Liu
- Department for Orthopaedics and Trauma Surgery, Siloah St. Trudpert Hospital, Pforzheim, Germany
| | - Philip Lazaru
- Center for Surgery, Evangelical Hospital Ludwigsfelde-Teltow, Ludwigsfelde, Germany
| | - Ivan Marintschev
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| |
Collapse
|