Use of Surgical Approach Is Not Associated With Instability
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Posterolateral approach (PA) has been historically associated with an increased risk of dislocation after primary total hip arthroplasty (THA), especially when compared with the direct anterior approach (DAA). The purpose of this study is to determine whether surgical approach influences joint stability.

Methods:
Randomized controlled trials (RCTs) and non-RCTs comparing DAA with PA in primary THA were included. Pooled effect measure of risk differences, relative risk and mean differences for postoperative dislocation, acetabular implant positioning, and leg length discrepancy were calculated.

Results:
--25 studies (5 RCTs and 20 non-RCTs) of 7,172 THAs were assessed. There were no significant differences in dislocation rates between approaches (risk difference = ?0.00).
--Results were similar in the subgroup analysis of RCTs (P = 0.98), posterior soft-tissue repair (P = 0.50), and learning curve (P = 0.77).
--The acetabular implant was better positioned within the safe zone in the DAA group (relative risk = 1.17), but no significant differences were found in cup inclination (P = 0.8), anteversion (P = 0.10), and leg length discrepancy (P = 0.54).

Conclusively, dislocation rates after THA are not different between DAA and PA. Furthermore, no differences in the rate of dislocation were associated with cup positioning or surgical factors related with hip instability. Therefore, the surgical approach has little influence in prosthesis instability after primary THA.

Source: https://journals.lww.com/jaaos/Abstract/9900/Use_of_Surgical_Approach_Is_Not_Associated_With.58.aspx
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