Stolarczyk Artur, Stolarczyk Magda, Stępiński Piotr, Dorocińska Monika K, Świercz Maciej, Szymczak Jakub, Żarnovsky Krystian, Żuchniewicz Albert, Maciąg Bartosz M
Department of Orthopaedics and Rehabilitation, Medical University of Warsaw, 02-091 Warszawa, Poland.
3rd Clinic of Internal Medicine and Cardiology, Medical University of Warsaw, 02-091 Warszawa, Poland.
J Clin Med. 2021 May 21;10(11):2246. doi: 10.3390/jcm10112246.
Total hip arthroplasty (THA) is currently considered the most effective treatment for end-stage hip osteoarthritis (OA). The surgery can be performed via a number of different approaches, including direct anterior (DAA; Smith-Petersen; Hueter), anterolateral (ALA; Watson-Jones), direct lateral (LA; Bauer), posterior (PA; Kocher-Langenbeck), and posterolateral (PLA). There is still a dispute over the optimal technique. The aim of this systematic review was to assess how different surgical approaches toward a THA influence the prosthesis elements' positioning. We conducted a literature search of Scopus, ScienceDirect, PubMed, Embase, and The Cochrane Library. We evaluated studies in terms of the first author's name, country, publication year, type of surgical approach being compared to the direct anterior approach, any significant differences at baseline, sample size, and radiographic analysis. A subanalysis of each approach in comparison to the DAA revealed differences in terms of all analyzed implant positioning radiographic parameters. There is still an insufficient number of randomized controlled studies that include radiological analyses comparing THRs (total hip replacements) performed using DAA with other approaches. Implant placement is a crucial step during a THR and surgeons must be aware that the approach they use might impact their judgment on angles and spaces inside the joint and thus alter the implant positioning.
全髋关节置换术（THA）目前被认为是终末期髋关节骨关节炎（OA）最有效的治疗方法。该手术可以通过多种不同的入路进行，包括直接前路（DAA；史密斯-彼得森；休特尔）、前外侧入路（ALA；沃森-琼斯）、直接外侧入路（LA；鲍尔）、后路（PA；科赫尔-兰根贝克）和后外侧入路（PLA）。关于最佳技术仍存在争议。本系统评价的目的是评估THA的不同手术入路如何影响假体部件的定位。我们对Scopus、ScienceDirect、PubMed、Embase和考克兰图书馆进行了文献检索。我们根据第一作者姓名、国家、出版年份、与直接前路相比的手术入路类型、基线时的任何显著差异、样本量和影像学分析来评估研究。与DAA相比，对每种入路的亚分析揭示了所有分析的植入物定位影像学参数方面的差异。目前仍缺乏足够数量的随机对照研究，这些研究包括对使用DAA与其他入路进行的全髋关节置换术（THR）的放射学分析比较。植入物放置是THR过程中的关键步骤，外科医生必须意识到他们使用的入路可能会影响他们对关节内角度和间隙的判断，从而改变植入物的定位。
