Surgical Approaches in Total Hip Arthroplasty

Fragility of Statistical Differences Between Surgical Approaches in Total Hip Arthroplasty

BACKGROUND

Total hip arthroplasty (THA) is a successful treatment for hip osteoarthritis, but the optimal surgical approach for this procedure is a topic of debate. This review uses fragility analysis to determine the statistical fragility of randomized controlled trials (RCTs) comparing the 3 most common surgical approaches for THA: direct anterior, direct lateral, and posterior.

MATERIALS AND METHODS

A systematic review was conducted to identify RCTs comparing 2 of the 3 surgical approaches for THA. Dichotomous outcomes and study characteristics were extracted from each study that met the inclusion criteria. Fragility index (FI) and fragility quotient (FQ) were calculated for each significant outcome (P≤.05), and reverse fragility index and quotient (rFI and FQ) were calculated for each nonsignificant outcome (P>.05).

RESULTS

Our search yielded 20 studies in total, with 146 identified dichotomous outcomes. In total, the outcomes had a median FI of 5 and a median rFI of 5. Significant outcomes that favored the anterior approach had a median FI of 6, and significant outcomes that favored the posterior or lateral approach both had a median FI of 1.

CONCLUSION

The RCTs comparing approaches to THA had a median FI of 5, signifying that the reversal of 5 events would be sufficient to change the significance of the entire outcome. This value is comparable to other FI values within the orthopedic literature, but subgroup analyses elucidated areas of greater statistical fragility, particularly in outcomes favoring either the lateral or posterior approach in THA. [Orthopedics. 2025;48(3):166-173.].

Clinical relevance of patient-reported outcome measures in patients who have undergone total hip arthroplasty: a systematic review

INTRODUCTION

In orthopaedic research, it is crucial to determine changes that are statistically significant and clinically meaningful. One approach to accomplish this is by calculating the Minimal Clinically Important Difference (MCID), the Clinically Important Differences (CID), the Minimum Detectable Change (MDC), the Minimal Important Change (MIC), and the Patient Acceptable Symptom State (PASS) values. These tools assist medical professionals in comprehending the patient's viewpoint, enabling them to establish treatment objectives that align with patients' desires and expectations. The present systematic review investigated the MCID, MIC, CID, MDC, and PASS of the most used PROMs to assess patients who have undergone THA.

METHODS

This systematic review followed the 2020 PRISMA guidelines. Web of Science, Embase, and PubMed were accessed in March 2024 without time constraints or additional filters. All the clinical investigations which evaluated data tools (MCID, MIC, CID, MDC, and PASS) to assess the clinical relevance of PROMs in THA were accessed. Articles in Spanish, Italian, German, and English were eligible. Studies with levels of evidence I to III were eligible.

RESULTS

Data from 100,824 patients were collected. All relevant demographic data were analysed and summarised. In addition, the MCID, MIC, CID, MDC and PASS of the COMI, HOOS, SF-36, OHS, Oxford-12, PROMIS-PF, SF-12, and WOMAC scores for THA were determined.

CONCLUSION

Current evidence recommends to collect MCIDs based on anchors routinely. These values should be used as complementary tools to determine the clinical effectiveness of a treatment instead of solely relying on statistically significant improvements.

LEVEL OF EVIDENCE

Level IV, systematic review and meta-analysis.

A Comprehensive Review of Total Hip Arthroplasty Outcomes in Post-traumatic Hip Arthritis: Insights and Perspectives

Post-traumatic hip arthritis presents a challenging condition characterized by degenerative changes in the hip joint following traumatic injury. Total hip arthroplasty (THA) is a cornerstone in managing this condition, offering significant pain relief, functional improvement, and enhanced quality of life. This comprehensive review aims to synthesize existing literature to elucidate the outcomes of THA in post-traumatic hip arthritis, exploring factors influencing surgical success and identifying areas for further research. Key findings reveal favourable clinical outcomes associated with THA, though considerations such as patient characteristics, surgical techniques, and implant selection impact outcomes. Implications for clinical practice underscore the importance of tailored preoperative assessment and ongoing advancements in surgical approaches and implant technology. Furthermore, opportunities for future research lie in long-term durability studies, patient-reported outcomes assessment, and exploration of innovative surgical techniques. Overall, THA emerges as a promising intervention for post-traumatic hip arthritis, yet continual refinement through research and innovation remains imperative to optimize patient care in this population.