Direct Anterior Approach Total Hip Arthroplasty Is Not Associated with Increased Infection Rates: A Systematic Review and Meta-Analysis.

Autor:	O'Connor CM; Division of Orthopaedics, Department of Surgery, Albany Medical Center, Albany, New York., Anoushiravani AA; Division of Orthopaedics, Department of Surgery, Albany Medical Center, Albany, New York., Acosta E; Division of Orthopaedics, Department of Surgery, Albany Medical Center, Albany, New York., Davidovitch RI; Department of Orthopedic Surgery, Langone Orthopedic Hospital, Langone Health, New York, NY., Tetreault MW; Division of Orthopaedics, Department of Surgery, Albany Medical Center, Albany, New York.
Jazyk:	angličtina
Zdroj:	JBJS reviews [JBJS Rev] 2021 Jan 26; Vol. 9 (1), pp. e20.00047. Date of Electronic Publication: 2021 Jan 26.
DOI:	10.2106/JBJS.RVW.20.00047
Abstrakt:	Background: The direct anterior approach (DAA) for primary total hip arthroplasty (THA) has recently increased in popularity. Recent evidence has raised concerns about whether use of the DAA is associated with increased rates of superficial and deep infection. The aim of this study was to systematically assess the literature and comparatively evaluate the rate of superficial and deep infection following primary THA using the DAA and non-direct anterior (non-DAA) approaches. Methods: This study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement. Primary outcome measures evaluated were rates of superficial and deep infection in patients undergoing DAA and non-DAA primary THA. Results: A total of 1,872 studies were identified in the original search, of which 15 studies satisfied inclusion criteria. Our analysis evaluated 120,910 primary THAs, including 14,908 DAA and 106,002 non-DAA. The rate of superficial infection was 1.08% for DAA compared with 1.24% for non-DAA (odds ratio [OR] = 1.01, 95% confidence interval [CI] = 0.79 to 1.30, p = 0.921). The rate of deep infection was 0.73% for DAA compared with 0.51% for non-DAA (OR = 1.03, 95% CI = 0.80 to 1.32, p = 0.831). Conclusions: This study found no difference in the rate of superficial or deep infection after primary THA using the DAA versus other surgical approaches. Our results suggest that comparative infection risk need not be a primary driver in the choice of surgical approach. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Competing Interests: Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJSREV/A661). (Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.)
Databáze:	MEDLINE
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