A Meta-analysis Of Randomized Controlled Trials Of Two Approaches In THR

Background: With surgeons' increasing attention to the satisfaction and rapid recovery of patients THR in recent,the direct anterior approach,as an tissue sparing approach,is becoming more and more attention-getting.Many cadaver studies and clinical studies have confirmed that direct anterior approach has the advantages in decreasing tissue damage in operation and helping patients faster recovery after operation.But this approach has some disadvantages,such as it needs special surgical equipment,has a long learning curve,is difficult to master,and has a high incidence of neuropraxia of cutaneous nerve of thigh.The posterolateral approach is the most widely used all over the world at present.Although it has been reported that it has high rate of dislocation in postoperation,and the motions of the operative hip joint have to be restricted,the posterolateral approach has some advantages as well,such as simple to carry out and easy to be mastered by the surgeons.There are some Meta analysises to compare direct anterior approach and posterior approach in total hip replacement,But all of these articles were not only analysis of randomized controlled trials,and included few randomized controlled trials.And it has a noteworthy point that we only included the clinical randomized controlled trials in our research.Objectives: The purpose of this study was to compare the effectiveness and safety of the direct anterior approach with the traditional posterolateral approach by the Meta analysis of clinical randomized controlled trials.Methods:We searched the data bases of Pubmed?Embase?Cochrane library?Web of science?China National Knowledge Infrastructure?China Biology Medicine disc,to find out all of the randomized controlled trials which Compared the direct anterior approach and posterolateral approach in total hip replacement.Each of the patients in the included articles must be an adult,and sufferd from one of the following three diseases: dysplasia of the hip,aseptic necrosis of the femoral head,primary and secondary osteoarthritis of the hip,and require surgical treatment.The indexes to analysis include the operation time,the length of the incision,the blood loss,the time of hospitalization,visual analogue scale(VAS)score,Harris score,complication,and cup Orientation.The datas were merged by Rev Man 5.3,and the descriptive analysis were used when the studies could not combined.Results: By searching the databases above,We finally got 10 articles meeting our inclusion criteria.The 10 articles contain 654 patients.There are 329 patients in the direct anterior approach group and 325 patients in the posterolateral approach group.Through the data merging,We found the two groups had no statistical difference in Operative incision length(MD=-0.92,95CI[-4.06,2.76],P=0.62)?Operation time(MD=7.95,95%CI[-0.86,16.59],P=0.07)? Blood loss(SMD=-0.72,95%CI[-0.18,0.36],P=0.19)? Incidence of fracture(RR=0.59,95%CI[0.24,1.48],P=0.26,I2=28%)? Postoperative dislocation rate(RR=0.63,95%CI[0.09,4.65],P=0.65,I2=0%).The direct anterior approach had shorter length of hospital stay(MD=-0.51,95%CI[-0.74,-0.27],P<0.001)?lower pain VAS score(first day after operation:MD=-0.66,95%CI[-0.95,-0.37],P<0.00001,I2=0%;second day after operation:MD=-0.67,95%CI[-1.34,0.01],P=0.05)and lower Acetabular Inclination angle(MD=-0.96,95%CI[-1.70,-0.21],P=O.O1,I2=0%).By combination of descriptive analysis and data merging,we found that the augment of creatine kinase in the direct anterior approach group postoperatively was not as obvious as that in posterolateral approach group.Although the posterolateral approach group had some superior results to the direct anterior approach group in postoperative function change at some aspects,all in all,the direct anterior approach group has obvious advantages over the posterior approach group.Conclusion: Direct anterior approach can reduce the damage of soft tissue during operation,relieve postoperative pain and lead to faster postoperative recovery and is more accurate in placement of the acetabular prosthesis,when compare to posterolateral approach.But there is no significant difference in a long postoperative time...