Publication:

Comparison of surgical approaches of total hip arthroplasty in Crowe 3/4 dysplastic hips in adults: a systematic review and meta-analysis

Developmental dysplasia of the hip (DDH) presents unique challenges for total hip arthroplasty (THA) due to altered anatomy, requiring tailored surgical approaches. Differences in outcomes such as Harris Hip Score (HHS), leg length discrepancy (LLD), operative variables, and postoperative complications between THA approaches remain unclear. This meta-analysis aimed to evaluate variations in functional outcomes, operative data, and postoperative complications among THA approaches in adult patients with DDH, focusing on direct anterior (DAA), posterolateral (PLA), and anterolateral (ALA) approaches, as well as osteotomy versus non-osteotomy techniques. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we systematically searched PubMed, Cochrane, and manual sources for retrospective studies published until March 2024. An inverse variance pooling meta-analysis was conducted. Thirty-five studies (1501 hips; 1246 patients; mean age 46.9 years; mean follow-up 7 years) were included. HHS improved by 47.08 points with no significant differences between approaches (p=0.81) or osteotomy groups (p=0.96). LLD reduced by 3.50 cm overall, with the posterior approach achieving the greatest reduction (-3.67 cm, p=0.03). Operative time (148.47 minutes) and blood loss (832.74 ml) did not differ significantly between DAA and PLA (p=0.59 and p=0.08, respectively). Minor complications, including nerve palsy and non-union, were rare. Dislocation rates were higher with the posterior approach (2%, p=0.04), while infection rates were negligible (0%). THA approaches in DDH yield comparable functional and operative outcomes. The posterior approach achieved the greatest LLD reduction but had a higher risk of dislocation, highlighting the need for careful approach selection.