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Archives of Orthopaedic and Trauma Surgery

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01-08-2015 | Hip Arthroplasty

Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis

Authors: Thomas De Geest, Peter Fennema, Gerlinde Lenaerts, Geert De Loore

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 8/2015

Abstract

Introduction

The direct anterior approach (DAA) is an increasingly popular technique for performing total hip arthroplasty (THA). This muscle-sparing approach may yield functional benefits. However, DAA has been associated with an increased risk incidence (RI) of intra- and postoperative complications.

Materials and methods

A systematic review of the published literature was conducted to document the cumulative RI of intra- and postoperative complications, as well as the presence of a learning curve in subjects undergoing THA with a DAA. Study selection and data extraction were carried out independently in duplicate. A Bayesian zero-inflated random-effect model was used to calculate pooled estimates for the different endpoints.

Results

Thirty-eight studies (6485 patients) were analysed. RIs of 0.8 % [95 % confidence interval (CI): 0.4–1.6 %] and 0.5 % (95 % CI: 0.3–0.9 %) were found for intra-operative trochanter and femoral fractures, respectively, and of 0.9 % (95 CI: 0.3–2.6 %) for postoperative transient lateral cutaneous femoral nerve (LCFN) impairment. A clear RI for early revisions (2.1 %; 95 % CI: 1.4–2.8 %) and other surgical re-interventions (1.3 %; 95 % CI: 0.7–1.9 %) was present, but these values do not differ from reported RIs for THA overall. The RI for dislocation was low (0.6 %; 95 % CI: 0.4–0.9 %) compared with the reported literature.

Conclusions

DAA is a technically demanding procedure, with outcomes possibly indicative of surgeon learning curve. A risk for intra-operative fractures and LCFN is evident, although the risk for other adverse effects is comparable to those with other approaches.

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Title: Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis
Authors: Thomas De Geest
Peter Fennema
Gerlinde Lenaerts
Geert De Loore
Publication date: 01-08-2015
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 8/2015
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-015-2258-y

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Springer Medicine

Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis

Abstract

Introduction

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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