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Influence of surgical approach on complication risk in primary total hip arthroplasty.
- Source :
- Acta Orthopaedica; Jun2018, Vol. 89 Issue 3, p289-294, 6p, 1 Diagram, 4 Charts
- Publication Year :
- 2018
-
Abstract
- Background and purpose — Systematic comparisons of anterior approach (A) versus posterior approach (P) in primary total hip arthroplasty (THA) have largely focused on perioperative outcomes. In this systematic review with meta-analysis, we compared complication risk of A versus P in studies of primary THA with at least 1-year mean follow-up. Patients and methods — We performed a systematic review of prospective and retrospective studies with at least 1-year mean follow-up that reported complications of A and P primary THA. Complications included infection, dislocation, reoperation, thromboembolic event, heterotopic ossification, wound complication, fracture, and nerve injury. Random effects meta-analysis was used for all outcomes. Complication risk was reported as rate ratio (RR) to account for differential follow-up durations; values >1 indicated higher complication risk with A and values <1 indicated lower risk with A. Results — 19 studies were included; 15 single-center comparative studies with 6,620 patients (2,278 A; 4,342 P) and 4 multicenter registries with 157,687 patients (18,735 A; 138,952 P). Median follow-up was 16 (12-64) months) with A and 18 (12-110) months with P. Anterior approach was associated with lower rate of infection (RR =0.55, p = 0.002), dislocation (RR =0.65, p = 0.03), and reoperation (RR =0.84, p < 0.001). No statistically significant differences were observed in rate of thromboembolic event (RR =0.59, p = 0.5), heterotopic ossification (RR =0.63, p = 0.1), wound complication (RR =0.93, p = 0.8), or fracture (RR =1.0, p = 0.9). There was a higher rate of patient-reported nerve injury with A (RR =2.3, p = 0.01). Interpretation — Comparing A with P in primary THA, A was associated with lower risk of reoperation, dislocation, and infection, but higher risk of patient-reported nerve injury. [ABSTRACT FROM AUTHOR]
- Subjects :
- INFECTION risk factors
NERVOUS system injuries
THROMBOEMBOLISM risk factors
RISK factors of fractures
SURGICAL complication risk factors
JOINT dislocations
METAPLASTIC ossification
SURGICAL site infections
REPORTING of diseases
PATIENT aftercare
LONGITUDINAL method
META-analysis
HEALTH outcome assessment
REOPERATION
TOTAL hip replacement
SYSTEMATIC reviews
RELATIVE medical risk
RETROSPECTIVE studies
INJURY risk factors
DISEASE risk factors
Subjects
Details
- Language :
- English
- ISSN :
- 17453674
- Volume :
- 89
- Issue :
- 3
- Database :
- Complementary Index
- Journal :
- Acta Orthopaedica
- Publication Type :
- Academic Journal
- Accession number :
- 129471822
- Full Text :
- https://doi.org/10.1080/17453674.2018.1438694