Background: Currently in the UK, posterior and lateral surgical approaches are routinely performed for hip replacement, with medial parapatellar and subvastus approaches used for knee replacement. To ensure best patient care, surgeons need robust evidence to inform t he choice of surgical approach. Aims: To compare outcomes after different surgical approaches in hip and knee re placement, I conducted a series of systematic reviews and meta-analyses. Methods: Using Cochrane methods, I conducted literature searches to identify randomised controlled trials comparing approaches for hip and knee replacement. Functional outcomes and adverse events were compared in meta-analyses. Results: Six studies including 517 hip replacements showed a lower risk of Trendelenburg gait (Odds Ratio 0.31L but no functional advantage following the posterior approach compared with the lateral approach. Sixteen studies including lA98 hip replacements compared posterior and minimally invasive posterior approaches to the hip. Clinically insignificant improvements in functional outcome, operating time, hospital stay and blood loss were observed following the minimally invasive posterior approach. Adverse events were similar between approaches. Eighteen studies including 1,711 knee replacements compared subvastus and medial parapatellar approaches. The Knee Society score was improved by 7.7 points (95%CI 5.25, 10.05) at six weeks post-surgery, and 2.8 points (95%CI 0.83,4.85) at one year in the subvastus group compared with the medial para patellar group. Adverse events were similar between approaches. Conclusions: In hip replacement, the minimally invasive posterior approach appears equivalent to the standard posterior approach for functional outcome and adverse events whilst limiting incision length. In knee replacement, small clinically insignificant benefits in functional outcome, acute pain, and time to regain active straight leg raise were associated with the subvastus approach. There were no differences in the rates of adverse events. My research identifies the need for a high quality randomised trial comparing posterior and lateral approaches in hip replacement.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:691247 |
| Date | January 2016 |
| Creators | Berstock, James Robert |
| Publisher | University of Bristol |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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