• Arch Orthop Trauma Surg · Aug 2020

    Review Meta Analysis

    Implant positioning among the surgical approaches for total hip arthroplasty: a Bayesian network meta-analysis.

    • Filippo Migliorini, Jörg Eschweiler, Andromahi Trivellas, Björn Rath, Arne Driessen, Markus Tingart, and Paolo Arentini.
    • Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany. migliorini.md@gmail.com.
    • Arch Orthop Trauma Surg. 2020 Aug 1; 140 (8): 1115-1124.

    IntroductionAlthough there is anatomical individuality among patients, some standardized requirements for component orientation for total hip arthroplasty (THA) exist. To date, no study has compared implant positioning using a network meta-analysis (NMA). Hence, the purpose of this study was to perform a NMA comparing implant positioning among the various approaches for THA.MethodsThis study was conducted according to the PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions. All randomized (RCT) and non-randomized (nRCT) clinical trials comparing two or more different approaches for THA were considered for inclusion. For the statistical analysis, the STATA Software/ MP, Version 14.1 (Stata Corporation, College Station, Texas, USA) was used. The NMA was performed through a Stata routine for Bayesian hierarchical random-effects model analysis.ResultsWe enrolled in the present study, a total of 4060 patients, with a mean of 17.84 ± 16.41 months follow-up. The patient baseline data were very homogeneous across the groups concerning age (P = 0.91), sex (P = 0.52), and BMI (P = 0.83). Concerning the cup anteversion, the anterolateral approach reported the value closest to the reference value. The test for overall inconsistency, however, was not statistically significant (P = 0.30). Concerning cup inclination, the lateral approach reported the value closest to the reference value. The test for overall inconsistency was statistically significant (P = 0.01).ConclusionThe anterolateral approach for total hip arthroplasty detected the best femoral stem alignment and cup anteversion. Data concerning cup inclination detected no sufficient transitivity to draw consistent conclusions.

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