VIA POSTERIOR VERSUS VIA ANTERIOR PARA ARTROPLASTIA TOTAL DO QUADRIL: REVISÃO SISTEMÁTICA E METANÁLISE DE ESTUDOS CLÍNICOS RANDOMIZADOS

FAGOTTI, LORENZO; FALOTICO, GUILHERME GUADAGNINI; MARANHO, DANIEL AUGUSTO; AYENI, OLUFEMI R.; EJNISMAN, BENNO; COHEN, MOISES; ASTUR, DIEGO COSTA

doi:10.1590/1413-785220212906244610

LORENZO FAGOTTI

Universidade Federal de São Paulo, Department of Orthopedics and Traumatology, Sports Traumatology Center (CETE), São Paulo, SP, Brazil.

Hospital Sírio-Libanês, Brasília, DF, Brazil.

https://orcid.org/0000-0001-9008-9480

GUILHERME GUADAGNINI FALOTICO

Universidade Federal de São Paulo, Department of Orthopedics and Traumatology, Sports Traumatology Center (CETE), São Paulo, SP, Brazil.

https://orcid.org/0000-0002-4189-574X

DANIEL AUGUSTO MARANHO

Hospital Sírio-Libanês, Brasília, DF, Brazil.

University of São Paulo, Ribeirão Preto Medical School, Ribeirão Preto, SP, Brazil

https://orcid.org/0000-0002-3893-0292

OLUFEMI R. AYENI

Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada.

https://orcid.org/0000-0003-4219-8564

BENNO EJNISMAN

Universidade Federal de São Paulo, Department of Orthopedics and Traumatology, Sports Traumatology Center (CETE), São Paulo, SP, Brazil.

https://orcid.org/0000-0002-3301-1457

MOISES COHEN

Universidade Federal de São Paulo, Department of Orthopedics and Traumatology, Sports Traumatology Center (CETE), São Paulo, SP, Brazil.

https://orcid.org/0000-0001-7671-8113

DIEGO COSTA ASTUR

Universidade Federal de São Paulo, Department of Orthopedics and Traumatology, Sports Traumatology Center (CETE), São Paulo, SP, Brazil.

https://orcid.org/0000-0001-9163-7979

Correspondence: Lorenzo Fagotti. Rua Napoleão de Barros, 715, Vila Clementino, São Paulo, SP, Brazil, 04024000. lorenzo_fagotti@hotmail.com

All authors declare no potential conflict of interest related to this article.

AUTHORS’ CONTRIBUTIONS:

Each author contributed individually and significantly to the development of this article. FL: writing and data analysis; FGG: writing and data analysis; MDA: article review and intellectual concept; AOR: article review; EB: article review; CM: article review; ADC: article review and intellectual concept.

Domain (order)	Inclusion criterion
Study design (1)	Study comparing study posterior versus anterior approach.
Population (2)	18-year old or older individuals undergoing primary THA.
Intervention (3)	Anterior, single-incision, (modified-Heuter, Smith-Petersen) Approach THA, Direct Anterior approach.
Control (4)	Posterior (Moore or Southern) Approach THA, Posterolateral, MIS-posterior.
Outcome measures (5)	One quantifiable clinical outcome measured by a validated score.

Continuous Variables
Number of patients undergoing THA
Age
BMI
Functional outcome scores
Pain scores
Follow-up time
Operative time
Length of hospital stay
Surgeon’s experience
Time for discontinuing walking aid
Postoperative opioid use
Categorical Variables
Gender
Major complications
Minor complications
Country of study

Lead author / Country	AA/PA (N)	Maximum follow-up (months)	HHS³²32. Lieberman JR, Dorey F, Shekelle P, Schumacher L, Kilgus DJ, Thomas BJ, et al. Outcome after total hip arthroplasty: comparison of a traditional disease-specific and a quality-of-life measurement of outcome. J Arthroplasty. 1997;12(6):639-45.^),(³³33. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969:51. mean SD at maximum follow-up AA/PA	Other functional scores reported in included studies	Major complications AA/PA	Minor complications AA/PA
					F = Fractures	NX = Neuropraxia
					D = Dislocations (N)	V = DVT (N)
Moerenhout et al. 2020²³23. Moerenhout K, Derome P, Laflamme GY, Leduc S, Gaspard H, Benoit B. Direct anterior versus posterior approach for total hip arthroplasty: a multicentric prospective randomized clinical study. Can J Surg. 2020;63(5):E412-7./Canada	28/27	60	82 ± 19.8/	NR	F. 0/2	NX. 0/0
	28/27	60	80 ± 20.4	NR	D. 0/0	V. 0/0
Barret et al.2019¹⁵15. Barrett WP, Turner SE, Murphy JA, Flener JL, Alton TB. Prospective, randomized study of direct anterior approach vs posterolateral approach total hip arthroplasty: a concise 5-year follow-up evaluation. J Arthroplasty. 2019;34(6):1139-42. /U.S.	39/40	60	NR	UCLA³⁴34. Amstutz HC, Thomas BJ, Jinnah R, Kim W, Grogan T, Yale C. Treatment of primary osteoarthritis of the hip: a comparison of total joint and surface replacement arthroplasty. J Bone Joint Surg. 1984;66A:228.^),(³⁵35. Beaulé PE, Dorey FJ, Hoke R, Le Duff M, Amstutz HC. The value of patient activity level in the outcome of total hip arthroplasty. J Arthroplasty; 2006;21(4):547-55.	F. 0/0	NX. 0/0
	39/40	60	NR	HOOS Jr	D. 0/0	V. 0/1
Bon et al. 2019¹⁶16. Bon G, Kacem EB, Lepretre PM, Weissland T, Mertl P, Dehl M, et al. Does the direct anterior approach allow earlier recovery of walking following total hip arthroplasty? A randomized prospective trial using accelerometry. Orthop Traumatol Surg Res. 2019;105(3):445-52./France	50/50	3	89.95 ± 12.73/	OHS³⁶36. Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, et al. The use of the Oxford Hip and Knee Scores. J Bone Joint Surg Br. 2007;89:1010-4.^),(³⁸38. Nilsdotter AK, Lohmander LS, Klässbo M, Roos EM. Hip disability and osteoarthritis outcome score (HOOS) - validity and responsiveness in total hip replacement. BMC Musculoskelet Disord. 2003;4:10.	F. 0/0	NX. 8/0
	50/50	3	91.3 ± 9.48		D. 0/0*	V. 1/0
Taunton et al. 2018²¹21. Taunton MJ, Trousdale RT, Sierra RJ, Kaufman K, Pagnano MW. John Charnley Award: randomized clinical trial of direct anterior and miniposterior approach tha: which provides better functional recovery? Clin Orthop Relat Res. 2018;476(2):216-29./U.S.	52/49	12	97 ± 4/	HOOS³⁷37. Sariali E, Leonard P, Mamoudy P. Dislocation after total hip arthroplasty using Hueter anterior approach. J Arthroplasty. 2008;23(2):266-72.^),(³⁹39. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833-40.	F. 0/2	NX. 0/0
	52/49	12	95 ± 7		D. 1/1	V. 0/1
Rykov et al. 2017²⁰20. Rykov K, Reininga IHF, Sietsma MS, Knobben BAS, Ten Have BLEF. Posterolateral vs direct anterior approach in total hip arthroplasty (POLADA Trial): a randomized controlled trial to assess differences in serum markers. J Arthroplasty. 2017;32(12):3652-8./Netherlands	23/23	1.5	93 ± 10.87/	HOOS	NR	NR
	23/23	1.5	90 ± 9.14	HOOS	NR	NR
Zhao et al 2017²²22. Zhao HY, Kang PD, Xia YY, Shi XJ, Nie Y, Pei FX. Comparison of early functional recovery after total hip arthroplasty using a direct anterior or posterolateral approach: a randomized controlled trial. J Arthroplasty. 2017;32(11):3421-8./China	64/64	6	92.2 ± 13.25	UCLA	F. 1/0	NX. 0/0
	64/64	6	89.9 ± 11.74	UCLA	D. 0/0	V. 0/0
Cheng et al. 2016¹⁷17. Cheng TE, Wallis JA, Taylor NF, Holden CT, Marks P, Smith CL, et al. A prospective randomized clinical trial in total hip arthroplasty-comparing early results between the direct anterior approach and the posterior approach. J Arthroplasty. 2017;2(3):883-90./Australia	35/38	3	NR	OHS	F. 2/0	NX. 29/0
	35/38	3	NR	WOMAC³⁹39. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833-40.	D. 1/1	V. 0/1
Christensen et al. 2015¹⁹19. Christensen CP, Jacobs CA. Comparison of patient function during the first six weeks after direct anterior or posterior total hip arthroplasty (THA): a randomized study. J Arthroplasty. 2015;30(9 Suppl):94-7./U.S.	28/23	1.5	NR	NR	NR	NR
Taunton et al 2014¹⁴14. Taunton MJ, Mason JB, Odum SM, Springer BD. Direct anterior total hip arthroplasty yields more rapid voluntary cessation of all walking aids: a prospective, randomized clinical trial. J Arthroplasty. 2014;29(9 Suppl):169-72./U.S.	27/27	12	97.5 ± 1.70/	WOMAC	F. 2/1	NX. 0/0
	27/27	12	95.5 ± 3.73	WOMAC	D. 0/0	V. 0/0
Barrett et al. 2013¹⁸18. Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty. 2013;28(9):1634-8./U.S.	43/44	12	97.5 ± 5.7/	HOOS	F. 0/1	NX. 0/0
	43/44	12	97.3 ± 5.5	HOOS	D. 0/1	V. 0/0
N total Mean follow-up Total complications	361/358	12.34	94.52 ± 8/	-	F. 5/6	NX. 37/0
N total Mean follow-up Total complications	361/358	12.34	93.2 ± 7.76	-	D. 2/3	V. 1/3

[1] Correspondence: Lorenzo Fagotti. Rua Napoleão de Barros, 715, Vila Clementino, São Paulo, SP, Brazil, 04024000. lorenzo_fagotti@hotmail.com

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VIA POSTERIOR VERSUS VIA ANTERIOR PARA ARTROPLASTIA TOTAL DO QUADRIL: REVISÃO SISTEMÁTICA E METANÁLISE DE ESTUDOS CLÍNICOS RANDOMIZADOS

RESUMO

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