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Minimally invasive anterolateral approach versus lateral transmuscular approach for total hip arthroplasty: A
Tomonori Shigemura1, Yasuaki Murata1, Yohei Yamamoto1
1Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan.
Background:
Total hip arthroplasty (THA) using a minimally invasive (MI) approach is a commonly performed procedure, and several approaches are now being used clinically. The MI anterolateral (MIAL) approach is one of the MI approaches used in clinical practice. Whether the MIAL approach is superior to non-MI approaches remains controversial. To resolve this controversy, we performed a systematic review and a meta-analysis of results of THA procedures that used the MIAL approach. We assessed whether the MIAL approach was superior to the lateral transmuscular (LT) approach in terms of operative time, operative blood loss, radiological parameters, and clinical outcomes.
Methods:
We performed a methodical search for all literature published on PubMed, Web of Science, and the Cochrane Library, and pooled data using the RevMan software. A p value < 0.05 was considered statistically significant. We calculated the mean differences (MD) for continuous data with 95% confidence intervals (CI) for each outcome.
Results:
This meta-analysis included 6 studies. Pooled results indicated no statistically significant differences between the groups in terms of operative time (MD = 5.13, 95% CI -2.49 to 12.75, p = 0.19), cup abduction angle (MD = 1.64, 95% CI -1.32 to 4.60, p = 0.28), and cup anteversion angle (MD = 0.75, 95% CI -1.09 to 2.59, p = 0.43). Operative blood loss was significantly greater in those who underwent THA via the MIAL approach than those who underwent THA via the LT approach (MD = 68.01, 95% CI 14.69 to 121.33, p = 0.01). The postoperative Harris hip score (HHS) assessed at the time of final follow-up was significantly higher in those who underwent THA via the MIAL approach than those who underwent THA via the LT approach (MD = 1.41, 95% CI 0.50 to 2.33, p = 0.002).
Conclusion:
We conclude that the MIAL approach is superior to the LT approach in terms of clinical outcomes.
Level Of Evidence:
Level Ⅱ.
Insights
The minimally invasive anterolateral (MIAL) approach for total hip arthroplasty (THA) shows superior clinical outcomes compared to the lateral transmuscular (LT) approach. While operative blood loss is higher with MIAL, patient hip scores improve significantly.
Area of Science:
- Orthopedic Surgery
- Minimally Invasive Procedures
- Arthroplasty
Background:
- Minimally invasive (MI) total hip arthroplasty (THA) is common, with the MI anterolateral (MIAL) approach widely used.
- Controversy exists regarding the superiority of the MIAL approach over non-MI techniques.
- This study systematically reviewed and meta-analyzed THA results comparing the MIAL and lateral transmuscular (LT) approaches.
Purpose of the Study:
- To compare the MIAL approach with the LT approach in total hip arthroplasty.
- To evaluate differences in operative time, blood loss, radiological parameters, and clinical outcomes.
- To resolve controversy regarding the MIAL approach's efficacy.
Main Methods:
- Systematic review and meta-analysis of 6 studies.
- Literature search of PubMed, Web of Science, and Cochrane Library.
- Data pooled using RevMan software; statistical significance set at p < 0.05.
Main Results:
- No significant differences in operative time (p=0.19), cup abduction angle (p=0.28), or cup anteversion angle (p=0.43).
- Significantly greater operative blood loss with the MIAL approach (MD=68.01, p=0.01).
- Significantly higher postoperative Harris hip scores (HHS) with the MIAL approach (MD=1.41, p=0.002).
Conclusions:
- The MIAL approach demonstrates superior clinical outcomes compared to the LT approach in total hip arthroplasty.
- Despite increased blood loss, the MIAL approach leads to better patient functional recovery.
- The findings support the MIAL approach for improved patient outcomes in THA.
