Hospitalization length, surgical duration, and blood lost among the approaches for total hip arthroplasty: a Bayesian ne
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REVIEW
Hospitalization length, surgical duration, and blood lost among the approaches for total hip arthroplasty: a Bayesian network meta‑analysis F. Migliorini1 · A. Trivellas2 · J. Eschweiler1 · Y. El Mansy1,4 · M. C. Mazzanti3 · M. Tingart1 · P. Arentini3 Received: 18 November 2019 / Accepted: 27 March 2020 © Istituto Ortopedico Rizzoli 2020
Abstract Despite the numerous studies, there is no consensus concerning the best approach for total hip arthroplasty (THA), and debates are ongoing. The purpose of this study was to perform a Bayesian network meta-analysis (NMA) comparing several approaches for primary THA. The focus was on peri-operative outcomes: surgical duration, total estimated blood loss, and length of the hospitalization. This Bayesian network meta-analysis was conducted according to the PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of health care interventions. In October 2019, the main databases were accessed. All the clinical trials comparing two or more different approaches for primary THA were assessed. For the methodology quality assessment, the PEDro score was performed. The Software STATA MP was used for the statistical analyses. The NMA was performed through the routine for Bayesian hierarchical random-effects analysis with the inverse variance statistic method for continuous variables. Data from 4843 procedures was analysed. Between patient’s demographic, good baseline comparability was found. The comparison total estimated blood loss detected statistically significant inconsistency (P = 0.01). The posterolateral approach reported the lowest value for the surgical duration. The test for overall inconsistency was statistically significant (P = 0.4). The posterolateral approach reported the shortest hospitalization length. The test for overall inconsistency was statistically significant (P = 0.9). The posterolateral approach reported shorter surgical duration and hospitalization length. Concerning the analysis of total estimated blood loss, no significant result was obtained. Data must be considered in the light of the limitations of the present study. Keywords Bayesian network meta-analysis · Total hip arthroplasty · Approaches · Hospitalization length · Surgical duration · Total estimated blood loss
Introduction
* F. Migliorini [email protected] 1
Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074 Aachen, Germany
2
Department of Orthopaedics, David Geffen School of Medicine at UCLA, Suite 755, Los Angeles, CA 90095, USA
3
Fondazione Pisana per la Scienza, Via Ferruccio Giovannini 13, 56017 Pisa, Italy
4
Department of Orthopedics and Traumatology, University of Alexandria, Alexandria, Egypt
Total hip arthroplasty (THA) is one of the most successful orthopaedic interventions, showing a rising trend in international demand [1, 2]. THA represents the gold standard of treatment for advanced degenerative diseases, such as osteoarthritis, osteonecrosis, or joint dysplasia [3–5]. THA has the
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