Introduction:

This study presents stratified meta-analysis and projected cost per case analysis of direct anterior approach (DAA) versus posterior approach (PA) in total hip arthroplasty (THA) to determine the best surgical approach and guarantee hip joint longevity.

Methods:

Several online databases were searched for clinical trials comparing DAA and PA in primary THA. The stratified analysis was conducted to test for confounding and biases across the different types of included trials. The average cost and probability were used to determine projected added costs of medical and surgical management for complications.

Results:

30 clinical trials included 11,562 patients who underwent THA. Almost 50% of these patients performed DAA. As compared to PA, both non-stratified and stratified analyses demonstrated that DAA has a significant higher incidence of the overall intra- and postoperative complications (non-stratified, OR 1.64; p = 0.003) (stratified, OR 4.12; p = 0.005), nerve injury (non-stratified, OR 22.0; p < 0.00001) (stratified, OR 0.28; p < 0.00001), higher rate of revision surgery (non-stratified; OR 1.54; p = 0.01) (stratified, OR 7.37; p = 0.006), and higher incidence of surgical wound complications (non-stratified; OR 1.67; p = 0.002) as compared to PA following primary THA. In addition, DAA demonstrated higher trends of incidence (non-statistically significant) of femur fracture (Non-stratified, OR 1.32, p = 0.10) and thrombo-embolic complications (Retrospective studies, OR 1.39, p = 0.69). However, PA demonstrated higher trends of incidence (non-statistically significant) of hip joint dislocation, as compared to DAA. (Stratified RCTs, OR 0.63, p = 0.65]. Collectively, this amounts a $421,068.68 surplus in DAA complication costs.

Conclusions:

PA may provide a more lucrative, safer approach to those undergoing THA given its comparable postoperative outcomes, reduced complication rates, and lower overall cost relative to DAA.

中文翻译：

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初次全髋关节置换术中直接前路与后路入路的再入院、翻修以及术中和术后并发症的风险：分层荟萃分析和基于概率的成本预测

介绍：

本研究提出了全髋关节置换术 (THA) 中直接前路 (DAA) 与后路 (PA) 的分层荟萃分析和预计每病例成本分析，以确定最佳手术方法并保证髋关节寿命。

方法：

搜索了几个在线数据库中比较 DAA 和 PA 在原发性 THA 中的临床试验。进行分层分析以测试不同类型纳入试验的混杂和偏倚。平均成本和概率用于确定并发症的医疗和手术管理的预计增加成本。

结果：

30 项临床试验包括 11,562 名接受 THA 的患者。这些患者中几乎 50% 进行了 DAA。与 PA 相比，非分层和分层分析均表明，DAA 的总体术中和术后并发症发生率显着较高（非分层，OR 1.64；p  = 0.003）（分层，OR 4.12；p  = 0.005） ，神经损伤（非分层，OR 22.0；p  <  0.00001）（分层，OR 0.28；p  < 0.00001），更高的翻修手术率（非分层；OR 1.54；p  = 0.01）（分层，OR 7.37；p  = 0.006），以及更高的手术伤口并发症发生率（非分层；OR 1.67；p = 0.002) 与初级 THA 后的 PA 相比。此外，DAA 显示股骨骨折（非分层，OR 1.32，p  = 0.10）和血栓栓塞并发症（回顾性研究，OR 1.39，p  = 0.69）的发生率趋势（无统计学意义）更高。然而，与 DAA 相比，PA 表现出更高的髋关节脱位发生率（无统计学意义）趋势。（分层 RCT，OR 0.63，p  = 0.65]。总的来说，这相当于 DAA 并发症成本的 421,068.68 美元盈余。

结论：

PA 可能为接受 THA 的患者提供一种更有利可图、更安全的方法，因为其术后结果相当，并发症发生率更低，总成本相对于 DAA 更低。