Comparison between ilioinguinal approach and modified Stoppa approach for the treatment of acetabular fractures: An updated systematic review and meta-analysis.

BACKGROUND: The modified Stoppa (MS) approach is an alternative to the ilioinguinal (IL) approach and three meta-analyses comparing these two approaches for the treatment of acetabular fractures were published previously. The aim of this study was to provide an updated systematic review and meta-analysis comparing the MS approach with the IL approach for the treatment of acetabular fractures and to answer the following question: are the results of the MS approach superior to those of the IL approach in terms of reduction quality, operative time, operative blood loss, complications, and clinical outcomes for treatment of acetabular fractures? PATIENTS AND METHODS: An updated systematic literature review was conducted using relevant original studies from various databases (PubMed, Web of Science and the Cochrane Library). Pooling of data was performed using RevMan software (version 5.3, Cochrane Collaboration, Oxford, UK). A p-value of<0.05 was considered to be significant. We calculated the mean differences (MDs) for continuous data and odds ratio (OR) for dichotomous data with 95% confidence intervals (CIs) for each outcome. Statistical heterogeneity was assessed based on I2 using the standard Chi2 test. When I2>50%, significant heterogeneity was assumed and a random-effects model was applied for the meta-analysis. A fixed-effects model was applied in the absence of significant heterogeneity. RESULTS: Six studies were included in this meta-analysis. The findings demonstrated that the rate of anatomical reduction was significantly higher in the MS approach than in the IL approach (I2=0%, OR=1.75, 95% CI: 1.13-2.69, p=0.01), the operative time was significantly shorter in the MS approach than in the IL approach (I2=88%, MD=-63.60, 95% CI: -93.01 - (-34.20), p<0.0001) and operative blood loss was significantly lower in the MS approach than in the IL approach (I2=75%, MD=-350.51, 95% CI: -523.45 - (-177.58), p<0.0001). There was no significant difference in the rate of nerve injury (I2=0%, OR=0.47, 95% CI: 0.16-1.39, p=0.17), the rate of vascular injury (I2=0%, OR=0.51, 95% CI: 0.17-1.49, p=0.22), the rate of infection (I2=0%, OR=0.53, 95% CI: 0.25-1.12, p=0.10), the rate of heterotopic ossification (I2=45%, OR=0.63, 95% CI: 0.22-1.85, p=0.40), and the rate of excellent or good clinical score (I2=21%, OR=1.15, 95% CI: 0.56-2.38, p=0.70) between the two approaches. DISCUSSION: The MS approach provided better reduction quality, shorter operative time, lower operative blood loss, although there were no significant differences in the rate of complications, and excellent or good clinical score between the two approaches. LEVEL OF EVIDENCE: III.

Minimally invasive anterolateral approach versus lateral transmuscular approach for total hip arthroplasty: A systematic review and meta-analysis.

BACKGROUND: Total hip arthroplasty (THA) using a minimally invasive (MI) approach is a commonly performed procedure, and several approaches are now being used clinically. The MI anterolateral (MIAL) approach is one of the MI approaches used in clinical practice. Whether the MIAL approach is superior to non-MI approaches remains controversial. To resolve this controversy, we performed a systematic review and a meta-analysis of results of THA procedures that used the MIAL approach. We assessed whether the MIAL approach was superior to the lateral transmuscular (LT) approach in terms of operative time, operative blood loss, radiological parameters, and clinical outcomes. METHODS: We performed a methodical search for all literature published on PubMed, Web of Science, and the Cochrane Library, and pooled data using the RevMan software. A p value < 0.05 was considered statistically significant. We calculated the mean differences (MD) for continuous data with 95% confidence intervals (CI) for each outcome. RESULTS: This meta-analysis included 6 studies. Pooled results indicated no statistically significant differences between the groups in terms of operative time (MD = 5.13, 95% CI -2.49 to 12.75, p = 0.19), cup abduction angle (MD = 1.64, 95% CI -1.32 to 4.60, p = 0.28), and cup anteversion angle (MD = 0.75, 95% CI -1.09 to 2.59, p = 0.43). Operative blood loss was significantly greater in those who underwent THA via the MIAL approach than those who underwent THA via the LT approach (MD = 68.01, 95% CI 14.69 to 121.33, p = 0.01). The postoperative Harris hip score (HHS) assessed at the time of final follow-up was significantly higher in those who underwent THA via the MIAL approach than those who underwent THA via the LT approach (MD = 1.41, 95% CI 0.50 to 2.33, p = 0.002). CONCLUSION: We conclude that the MIAL approach is superior to the LT approach in terms of clinical outcomes. LEVEL OF EVIDENCE: Level Ⅱ.

Is a portable accelerometer-based navigation system useful in total hip arthroplasty?: A systematic review and meta-analysis.

BACKGROUND: Precise implant alignment is a crucial prognostic factor for successful outcomes following total hip arthroplasty (THA). A portable accelerometer-based navigation (PN) device may achieve the same accuracy as that achieved by the computer-assisted navigation surgery technique, with the convenience of a conventional technique. Although the usefulness of PN in THA (PN-THA) has been reported, whether it is more accurate than performing THA with a conventional technique (CON-THA) remains controversial. The difference in surgical time between PN-THA and CON-THA is also unclear. Therefore, we conducted a systematic review and meta-analysis of studies comparing results of PN-THA with those of CON-THA. We focused on the following question: is PN-THA superior to CON-THA in terms of radiological parameters and surgical time? PATIENTS AND METHODS: A literature search was conducted in PubMed, Web of Science, and Cochrane Library, to identify studies that met the following inclusion criteria: randomised controlled trials (RCT) or non-RCT, studies involving patients who underwent PN-THA and patients who underwent CON-THA, studies including data on radiological parameters and surgical outcomes. Author names, publication year, country, study design, surgical approach, demographic characteristics of the participants (diagnosis, gender, age, and body mass index), and surgical outcomes (the radiological parameters and the surgical time) were extracted. We calculated the mean differences (MDs) for continuous data with 95% confidence intervals (CIs) for each outcome. p<0.05 was considered significant. RESULTS: Three studies were included in this meta-analysis. The meta-analysis showed that absolute deviation of the postoperative measured angles from the target position for the cup anteversion was significantly smaller in PN-THA than in CON-THA (MD=-1.70, 95% CI=-2.91 to -0.50, [p=0.005]). There was no significant difference in the absolute deviation of the postoperative measured angles from the target position for cup abduction between the groups (MD=-1.82, 95% CI=-4.32-0.67, [p=0.15]). The surgical time was significantly longer in PN-THA than in CON-THA (MD=8.58, 95% CI=4.05-13.10, [p=0.0002]). DISCUSSION: This systematic review and meta-analysis of studies comparing the results of PN-THA with those of CON-THA showed that the PN-THA is advantageous for precise cup implantation compared to CON-THA, although PN-THA has a longer surgical time compared to CON-THA. LEVEL OF EVIDENCE: III.