Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
Department of Information Engineering, University of Florence, via Santa Marta 3, Florence, Italy.
Int Orthop. 2019 Jul;43(7):1573-1582. doi: 10.1007/s00264-018-4124-3. Epub 2018 Aug 31.
There exist a relevant number of clinical trials comparing the minimally invasive surgery to the standard-invasive approach in total hip arthroplasty (THA). Up to date, there are still debates concerning the most effective approach in THA.
The purpose of this study is to compare the clinical outcomes concerning patients undergoing primary THA performed via the minimally invasive versus standard-invasive surgery incision.
The search was performed in the main databases, evaluating both quantitative and qualitative results. All the randomised controlled trials (RCTs) and non-randomised controlled trials (nRCTs) comparing the minimally invasive versus the standard-invasive approach were enrolled in this study. We focused on the clinical and radiological outcomes and on the complication rate. Study methodological quality was assessed performing the PEDro critical appraisal scale. All meta-analyses were performed using the Review Manager software. To analyse the publication's bias, we performed the Funnel plot.
We enrolled in our study 4761 patients, undergoing to 4842 total hip arthroplasties. The mean follow-up was 22.26 months. In favour of the minimally invasive group, we reported less total estimated blood loss, shorter surgical duration, and a shorter length of stay. In favour of the standard-invasive group, we reported a higher value of the Harris hip score. Concerning the radiological outcomes, we did not report substantial differences across the two exposures. No difference was observed regarding the risk of femoral fractures, dislocation, and revision rates. We evidenced an increasing risk occurred in an iatrogenic nerve palsy during the minimally invasive approach.
Based on currently available evidences concerning the outcomes following THA and the analysis of our results, we stated no remarkable benefits of the minimally invasive compared to the standard-invasive surgery.
有相当数量的临床试验比较了微创与标准入路在全髋关节置换术（THA）中的应用。目前，对于 THA 最有效的方法仍存在争议。
本研究旨在比较通过微创与标准入路行初次 THA 的患者的临床结局。
在主要数据库中进行了检索，评估了定量和定性结果。本研究纳入了所有比较微创与标准入路的随机对照试验（RCT）和非随机对照试验（nRCT）。我们关注的是临床和影像学结局以及并发症发生率。使用 PEDro Critical Appraisal Scale 评估研究方法学质量。所有的荟萃分析均使用 Review Manager 软件进行。为了分析发表偏倚，我们进行了漏斗图分析。
我们共纳入了 4761 名患者，共进行了 4842 例全髋关节置换术。平均随访时间为 22.26 个月。微创组的总估计失血量较少、手术时间较短、住院时间较短。标准入路组的 Harris 髋关节评分较高。在影像学结果方面，两组之间没有显著差异。两组在股骨骨折、脱位和翻修率方面的风险没有差异。我们发现微创组发生医源性神经麻痹的风险增加。
基于目前关于 THA 结果的证据和我们的结果分析，我们认为微创与标准入路相比没有显著优势。
