Machinski Elcio, Leibovitch Liron, Park Jae Yong, Sayudo Iqbal F, Fernandes André, Liba Tom, Conde Rodrigo Arruda, Tonon Pedro Henrique Cury, Gusmão Caio Veloso
Orthopaedics, State University of Ponta Grossa, Ponta Grossa, BRA.
Department of Medicine, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, ISR.
Cureus. 2024 Dec 16;16(12):e75795. doi: 10.7759/cureus.75795. eCollection 2024 Dec.
Simultaneous bilateral total hip arthroplasty (SimBTHA) offers benefits such as reduced hospital stay and costs for patients with bilateral hip disease. However, the optimal surgical approach remains uncertain. This study aimed to compare the perioperative outcomes of SimBTHA performed via the direct anterior approach (DAA) versus the posterior approach (PA). A systematic review and meta-analysis were conducted, including studies reporting outcomes of SimBTHA using DAA and PA. The primary outcome was the incidence of allogeneic blood transfusions, while secondary outcomes included blood loss and surgical complications, such as dislocations, periprosthetic fractures, and infections. Six studies were included, analyzing 944 patients, with 372 undergoing SimBTHA via DAA and 572 via PA. No significant difference was observed in the number of allogeneic blood transfusions between the two approaches (RR = 1.04; 95% CI: 0.76 to 1.43; p=0.63). DAA was associated with significantly lower blood loss compared to PA (MD = -31.51 mL; 95% CI: -43.07 to -19.94 mL; p=0.07). However, there was no significant difference in the rates of surgical complications between the two groups (RR = 0.63; 95% CI: 0.32 to 1.26; p=0.12). While DAA showed a benefit in reducing blood loss, it did not demonstrate superiority over PA regarding transfusion rates or surgical complications. These findings highlight the need for further randomized controlled trials with standardized methodologies and longer follow-up periods to better assess the optimal approach for SimBTHA.
同期双侧全髋关节置换术（SimBTHA）为双侧髋关节疾病患者带来了缩短住院时间和降低费用等益处。然而，最佳手术入路仍不明确。本研究旨在比较经直接前路（DAA）与后路（PA）进行SimBTHA的围手术期结果。进行了一项系统评价和荟萃分析，纳入了报告使用DAA和PA进行SimBTHA结果的研究。主要结局是异体输血的发生率，次要结局包括失血量和手术并发症，如脱位、假体周围骨折和感染。纳入了六项研究，分析了944例患者，其中372例通过DAA进行SimBTHA，572例通过PA进行。两种入路之间的异体输血数量未观察到显著差异（RR = 1.04；95% CI：0.76至1.43；p = 0.63）。与PA相比，DAA的失血量显著更低（MD = -31.51 mL；95% CI：-43.07至-19.94 mL；p = 0.07）。然而，两组之间的手术并发症发生率没有显著差异（RR = 0.63；95% CI：0.32至1.26；p = 0.12）。虽然DAA在减少失血量方面显示出益处，但在输血率或手术并发症方面并未显示出优于PA。这些发现凸显了需要进一步开展采用标准化方法和更长随访期的随机对照试验，以更好地评估SimBTHA的最佳入路。
