Yoo Jun-Il, Cha Yong-Han, Kim Kap-Jung, Kim Ha-Yong, Choy Won-Sik, Hwang Sun-Chul
Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, South Korea.
Department of Orthopedic Surgery, Eulji University Hospital, Dunsan-Seoro 95, Seo-gu, Daejeon, 35233, South Korea.
BMC Musculoskelet Disord. 2019 Feb 8;20(1):63. doi: 10.1186/s12891-019-2450-2.
Comparative studies of total hip arthroplasty using the direct anterior approach (DAA) compared with the anterolateral approach (ALA) by gait analysis compared the results of the two groups, the damage to the abductor muscle, with objective and detailed kinematic as well as kinetic data of actual gait. The purpose of this systematic review was to analyze the differences in gait such as time-dependent parameters, kinetics, and kinematics after THA using the DAA compared with ALA.
PubMed Central, OVID Medline, Cochrane Collaboration Library, Web of Science, EMBASE and AHRQ carried out a comprehensive search for all relevant randomized controlled trials and comparative studies, up to December 2018. Based on the following criteria, studies were selected: 1) study design: randomized controlled trials or non-randomized comparative studies; 2) study population: patients with primary osteoarthritis or avascular necrosis; 3) intervention: total hip arthroplasty by DAA or ALA; 4) Kinetic and kinematic data after gait analysis in the plains during postoperative follow-up.
Of the 148 studies, 7 randomized controlled trials and 5 comparative studies were finally included in this systematic review. The peak hip flexion within 3 months after surgery was described in two studies and was significantly higher in the DAA group. (OR = 1.90; 95% CI [1.67,2.13]; P < 0.01, Z = 16.18). The gait speed within 3 months after surgery was reported in 3 studies and was significantly higher in the DAA group than in the ALA group. (SMD = 0.17; 95% CI [0.12,0.22]; P < 0.01, Z = 6.62) There was no difference between the two groups in stride length, step length, and hip range of motion in sagittal plane.
In this meta-analysis, gait speed and peak hip flexion within 3 months after surgery were significantly higher in the DAA group than in the ALA group. Despite a few significant differences between two approaches, determining whether the reported differences in terms of postoperative gait values are clinically meaningful remains a substantial challenge.
通过步态分析对采用直接前路（DAA）与前外侧入路（ALA）进行全髋关节置换术的比较研究，对比了两组结果、外展肌损伤情况以及实际步态的客观详细运动学和动力学数据。本系统评价的目的是分析采用DAA与ALA进行全髋关节置换术后，在诸如时间相关参数、动力学和运动学等步态方面的差异。
截至2018年12月，在PubMed Central、OVID Medline、Cochrane协作网图书馆、Web of Science、EMBASE和AHRQ中对所有相关随机对照试验和比较研究进行全面检索。基于以下标准选择研究：1）研究设计：随机对照试验或非随机比较研究；2）研究人群：原发性骨关节炎或缺血性坏死患者；3）干预措施：采用DAA或ALA进行全髋关节置换术；4）术后随访期间在平地进行步态分析后的动力学和运动学数据。
在148项研究中，最终有7项随机对照试验和5项比较研究纳入本系统评价。两项研究描述了术后3个月内的髋关节屈曲峰值，DAA组显著更高。（比值比[OR]=1.90；95%置信区间[CI][1.67,2.13]；P<0.01，Z=16.18）。3项研究报告了术后3个月内的步态速度，DAA组显著高于ALA组。（标准化均数差[SMD]=0.17；95%CI[0.12,0.22]；P<0.01，Z=6.62）两组在步幅、步长和矢状面髋关节活动范围方面无差异。
在这项荟萃分析中，DAA组术后3个月内的步态速度和髋关节屈曲峰值显著高于ALA组。尽管两种入路之间存在一些显著差异，但确定所报告的术后步态值差异是否具有临床意义仍然是一项重大挑战。
