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European Journal of Orthopaedic Surgery & Traumatology

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30.07.2019 | Original Article • HIP - ARTHROPLASTY

Comparative outcomes between collared versus collarless and short versus long stem of direct anterior approach total hip arthroplasty: a systematic review and indirect meta-analysis

verfasst von: Phonthakorn Panichkul, Suthorn Bavonratanavech, Alisara Arirachakaran, Jatupon Kongtharvonskul

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 8/2019

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Abstract

Introduction

Early research shows several advantages of the direct anterior approach (DAA) in THA that claimed to be as effective but less invasive than the posterior approach. However, due to the difficult femoral exposure and possible complications related to femoral preparation, this approach may result in a higher rate of undersized stems when compared to other approaches. The present authors believe that the femoral implant design (collar or collarless stem, short or long stem) in a collared femoral stem may relate to lower rates of stem subsidence and limb length discrepancy (LLD) in mid-term to long-term follow-up when compared to collarless femoral stems. However, currently, there is no consensus as to which femoral implant design is the most suitable for DAA in THA.

Methods

This systematic review and meta-analysis aim to assess and compare postoperative complications (neurapraxia, wound infection, LFCN, hematoma, artery injury, cup malposition, embolism, fracture and implant loosening) and revision rates due to dislocation, periprosthetic fracture and implant migration after DAA using collared compared to collarless femoral stem and short femoral stem compared to long femoral stem in THA. These clinical outcomes consist of the postoperative complications and revision femoral stem due to neurapraxia, wound, LFCN and LLD. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results

Relevant studies that reported postoperative complications and revision of either implant were identified from Medline and Scopus from inception to June 6, 2018. Thirty-four studies were included for the analysis of DAA in THA; 23 studies were retrospective cohorts, four studies were prospective cohorts, and seven studies were RCTs. Thirty-one studies and three studies were included for analysis of collarless and collared femoral stems. Twenty-six studies were long femoral stems and eight studies were short femoral stems. Overall, there were 6825 patients (6457 in the collarless group and 368 in the collared group, 4280 in long stem and 2545 in short stem). A total of 469 and 66 patients had complications and revisions in the collarless group, and no patient had complications and revisions in the collared stem group. The total complication and revision rate per patient were 5% (95%CI 3.3%, 7%) and 0.9% (95%CI 0.6%, 1.2%) in all patients. The complication rate and revision rate were 5.7% (95%CI 3.8%, 7.7%) and 0.9% (95%CI 0.6, 1.2) in the collarless group. There was no prevalence of complications and revisions in the collared stem group. The complication rate and revision rate were 10.2% (95%CI 9%, 11.4%), 0.7% (95%CI 0.3%, 1%) and 5.2% (95%CI 3.1, 7.2), 1.5% (95%CI 1%, 2%) in short and long femoral stems, respectively. Indirect meta-analysis shows that collared femoral stem provided a lower risk of complications of 0.02 (95%CI 0.001, 0.30) when compared to collarless femoral stem. Long femoral stems had a lower risk of having complications of 0.57 (95%CI 0.48, 0.68) when compared to short femoral stems. In terms of revision, there is no statistically significant difference in collared femoral stem compared to collarless femoral stem and long femoral stem compared to short femoral stem.

Conclusion

In DAA THA, collared femoral stem and long femoral stem had decreased complication rates when compared to collarless femoral stem and short femoral stem by both direct and indirect meta-analysis methods. However, in terms of revision rates, there were no differences between all femoral stems (short versus long and collared versus collarless). Prospective randomized controlled studies are needed to confirm these findings as the current literature is still insufficient.

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Baker AS, Bitounis VC (1989) Abductor function after total hip replacement. An electromyographic and clinical review. J Bone Jt Surg Br 71(1):47–50CrossRef

Barrett WP, Turner SE, Leopold JP (2013) Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty 28(9):1634–1638. https://doi.org/10.1016/j.arth.2013.01.034 CrossRefPubMed

Bernard J, Razanabola F, Beldame J, Van Driessche S, Brunel H, Poirier T, Matsoukis J, Billuart F (2018) Electromyographic study of hip muscles involved in total hip arthroplasty: surprising results using the direct anterior minimally invasive approach. Orthop Traumat Surg Res OTSR. https://doi.org/10.1016/j.otsr.2018.03.013 CrossRef

Bingham JS, Spangehl MJ, Hines JT, Taunton MJ, Schwartz AJ (2018) Does intraoperative fluoroscopy improve limb-length discrepancy and acetabular component positioning during direct anterior total hip arthroplasty? J Arthroplasty. https://doi.org/10.1016/j.arth.2018.05.004 CrossRefPubMed

Brown ML, Plate JF, Holst DC, Bracey DN, Bullock MW, Lang JE (2017) A retrospective analysis of the merits and challenges associated with simultaneous bilateral THA using the direct anterior approach. Hip Int J Clin Exp Res Hip Pathol Therapy 27(2):169–174. https://doi.org/10.5301/hipint.5000449 CrossRef

Chen M, Luo Z, Ji X, Cheng P, Tang G, Shang X (2017) Direct anterior approach for total hip arthroplasty in the lateral decubitus position: our experiences and early results. J Arthroplasty 32(1):131–138. https://doi.org/10.1016/j.arth.2016.05.066 CrossRefPubMed

Cheng TE, Wallis JA, Taylor NF, Holden CT, Marks P, Smith CL, Armstrong MS, Singh PJ (2016) A prospective randomized clinical trial in total hip arthroplasty-comparing early results between the direct anterior approach and the posterior approach. J Arthroplasty. https://doi.org/10.1016/j.arth.2016.08.027 CrossRefPubMed

Christensen CP, Jacobs CA (2015) Comparison of patient function during the first six weeks after direct anterior or posterior total hip arthroplasty (THA): a randomized study. J Arthroplasty 30(9 Suppl):94–97. https://doi.org/10.1016/j.arth.2014.12.038 CrossRefPubMed

Cidambi KR, Barnett SL, Mallette PR, Patel JJ, Nassif NA, Gorab RS (2018) Impact of femoral stem design on failure after anterior approach total hip arthroplasty. J Arthroplasty 33(3):800–804. https://doi.org/10.1016/j.arth.2017.10.023 CrossRefPubMed

10.

Cohen EM, Vaughn JJ, Ritterman SA, Eisenson DL, Rubin LE (2017) Intraoperative femur fracture risk during primary direct anterior approach cementless total hip arthroplasty with and without a fracture table. J Arthroplasty 32(9):2847–2851. https://doi.org/10.1016/j.arth.2017.04.020 CrossRefPubMed

11.

De Geest T, Vansintjan P, De Loore G (2013) Direct anterior total hip arthroplasty: complications and early outcome in a series of 300 cases. Acta Orthop Belg 79(2):166–173PubMed

12.

Demey G, Fary C, Lustig S, Neyret P, si Selmi T (2011) Does a collar improve the immediate stability of uncemented femoral hip stems in total hip arthroplasty? A bilateral comparative cadaver study. J Arthroplasty 26(8):1549–1555. https://doi.org/10.1016/j.arth.2011.03.030 CrossRefPubMed

13.

Downing ND, Clark DI, Hutchinson JW, Colclough K, Howard PW (2001) Hip abductor strength following total hip arthroplasty: a prospective comparison of the posterior and lateral approach in 100 patients. Acta Orthop Scand 72(3):215–220. https://doi.org/10.1080/00016470152846501 CrossRefPubMed

14.

Eto S, Hwang K, Huddleston JI, Amanatullah DF, Maloney WJ, Goodman SB (2017) the direct anterior approach is associated with early revision total hip arthroplasty. J Arthroplasty 32(3):1001–1005. https://doi.org/10.1016/j.arth.2016.09.012 CrossRefPubMed

15.

Fahs AM, Koueiter DM, Kurdziel MD, Huynh KA, Perry CR, Verner JJ (2018) psoas compartment block vs periarticular local anesthetic infiltration for pain management after anterior total hip arthroplasty: a prospective, randomized study. J Arthroplasty. https://doi.org/10.1016/j.arth.2018.02.052 CrossRefPubMed

16.

Fransen B, Hoozemans M, Vos S (2016) Direct anterior approach versus posterolateral approach in total hip arthroplasty: one surgeon, two approaches. Acta Orthop Belg 82(2):240–248PubMed

17.

Goebel S, Steinert AF, Schillinger J, Eulert J, Broscheit J, Rudert M, Noth U (2012) Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach. Int Orthop 36(3):491–498. https://doi.org/10.1007/s00264-011-1280-0 CrossRefPubMed

18.

Goosen JH, Kollen BJ, Castelein RM, Kuipers BM, Verheyen CC (2011) Minimally invasive versus classic procedures in total hip arthroplasty: a double-blind randomized controlled trial. Clin Orthop Relat Res 469(1):200–208. https://doi.org/10.1007/s11999-010-1331-7 CrossRefPubMed

19.

Guild GN 3rd, Runner RP, Castilleja GM, Smith MJ, Vu CL (2017) Efficacy of hybrid plasma scalpel in reducing blood loss and transfusions in direct anterior total hip arthroplasty. J Arthroplasty 32(2):458–462. https://doi.org/10.1016/j.arth.2016.07.038 CrossRefPubMed

20.

Hallert O, Li Y, Brismar H, Lindgren U (2012) The direct anterior approach: initial experience of a minimally invasive technique for total hip arthroplasty. J Orthop Surg Res 7:17. https://doi.org/10.1186/1749-799x-7-17 CrossRefPubMedPubMedCentral

21.

Hamilton WG, Parks NL, Huynh C (2015) Comparison of cup alignment, jump distance, and complications in consecutive series of anterior approach and posterior approach total hip arthroplasty. J Arthroplasty 30(11):1959–1962. https://doi.org/10.1016/j.arth.2015.05.022 CrossRefPubMed

22.

Hartford JM, Bellino MJ (2017) The learning curve for the direct anterior approach for total hip arthroplasty: a single surgeon’s first 500 cases. Eur J Orthop Surg Traumatol Orthop Traumatol 27(5):483–488. https://doi.org/10.5301/hipint.5000488 CrossRef

23.

Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558. https://doi.org/10.1002/sim.1186 CrossRefPubMed

24.

Hoell S, Sander M, Gosheger G, Ahrens H, Dieckmann R, Hauschild G (2014) The minimal invasive direct anterior approach in combination with large heads in total hip arthroplasty—is dislocation still a major issue? a case control study. BMC Musculoskelet Disord 15:80. https://doi.org/10.1186/1471-2474-15-80 CrossRefPubMedPubMedCentral

25.

Homma Y, Baba T, Kobayashi H, Desroches A, Ozaki Y, Ochi H, Matsumoto M, Yuasa T, Kaneko K (2016) Safety in early experience with a direct anterior approach using fluoroscopic guidance with manual leg control for primary total hip arthroplasty: a consecutive one hundred and twenty case series. Int Orthop 40(12):2487–2494. https://doi.org/10.1007/s00264-016-3159-6 CrossRefPubMed

26.

Ilchmann T, Gersbach S, Zwicky L, Clauss M (2013) Standard transgluteal versus minimal invasive anterior approach in hip arthroplasty: a prospective, consecutive cohort study. Orthop Rev 5(4):e31. https://doi.org/10.4081/or.2013.e31 CrossRef

27.

Ji HM, Kim KC, Lee YK, Ha YC, Koo KH (2012) Dislocation after total hip arthroplasty: a randomized clinical trial of a posterior approach and a modified lateral approach. J Arthroplasty 27(3):378–385. https://doi.org/10.1016/j.arth.2011.06.007 CrossRefPubMed

28.

Kanda A, Kaneko K, Obayashi O, Mogami A, Morohashi I (2018) Preservation of the articular capsule and short lateral rotator in direct anterior approach to total hip arthroplasty. Eur J Orthop Surg Traumatol Orthop Traumatol. https://doi.org/10.1007/s00590-018-2166-2 CrossRef

29.

Kawarai Y, Iida S, Nakamura J, Shinada Y, Suzuki C, Ohtori S (2017) Does the surgical approach influence the implant alignment in total hip arthroplasty? Comparative study between the direct anterior and the anterolateral approaches in the supine position. Int Orthop 41(12):2487–2493. https://doi.org/10.1007/s00264-017-3521-3 CrossRefPubMed

30.

Khemka A, Mograby O, Lord SJ, Doyle Z, Al Muderis M (2018) Total hip arthroplasty by the direct anterior approach using a neck-preserving stem: safety, efficacy and learning curve. Indian J Orthop 52(2):124–132. https://doi.org/10.4103/ortho.IJOrtho_314_16 CrossRefPubMedPubMedCentral

31.

Kleinert K, Werner C, Mamisch-Saupe N, Kalberer F, Dora C (2012) Closed suction drainage with or without re-transfusion of filtered shed blood does not offer advantages in primary non-cemented total hip replacement using a direct anterior approach. Arch Orthop Trauma Surg 132(1):131–136. https://doi.org/10.1007/s00402-011-1387-1 CrossRefPubMed

32.

Meneghini RM, Elston AS, Chen AF, Kheir MM, Fehring TK, Springer BD (2017) Direct anterior approach: risk factor for early femoral failure of cementless total hip arthroplasty: a multicenter study. J Bone Jt Surg Am 99(2):99–105. https://doi.org/10.2106/jbjs.16.00060 CrossRef

33.

Mirza AJ, Lombardi AV Jr, Morris MJ, Berend KR (2014) A mini-anterior approach to the hip for total joint replacement: optimising results: improving hip joint replacement outcomes. Bone Jt J 96-b(11 Supple A):32–35. https://doi.org/10.1302/0301-620x.96b11.34348 CrossRef

34.

Nakamura J, Hagiwara S, Orita S, Akagi R, Suzuki T, Suzuki M, Takahashi K, Ohtori S (2017) Direct anterior approach for total hip arthroplasty with a novel mobile traction table—a prospective cohort study. BMC Musculoskelet Disord 18(1):49. https://doi.org/10.1186/s12891-017-1427-2 CrossRefPubMedPubMedCentral

35.

Nakata K, Nishikawa M, Yamamoto K, Hirota S, Yoshikawa H (2009) A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty 24(5):698–704. https://doi.org/10.1016/j.arth.2008.04.012 CrossRefPubMed

36.

Oinuma K, Eingartner C, Saito Y, Shiratsuchi H (2007) Total hip arthroplasty by a minimally invasive, direct anterior approach. Oper Orthop Traumatol 19(3):310–326. https://doi.org/10.1007/s00064-007-1209-3 CrossRefPubMed

37.

Panichkul P, Parks NL, Ho H, Hopper RH Jr, Hamilton WG (2016) New approach and stem increased femoral revision rate in total hip arthroplasty. Orthopedics 39(1):e86–e92. https://doi.org/10.3928/01477447-20151222-06 CrossRefPubMed

38.

Patton RS, Runner RP, Lyons RJ, Bradbury TL (2018) Clinical outcomes of patients with lateral femoral cutaneous nerve injury after direct anterior total hip arthroplasty. J Arthroplasty. https://doi.org/10.1016/j.arth.2018.04.032 CrossRefPubMed

39.

Perry CR Jr, Fahs AM, Kurdziel MD, Koueiter DM, Fayne RJ, Verner JJ (2018) Intraoperative psoas compartment block vs preoperative fascia iliaca block for pain control after direct anterior total hip arthroplasty: a randomized controlled trial. J Arthroplasty 33(6):1770–1774. https://doi.org/10.1016/j.arth.2018.01.010 CrossRefPubMed

40.

Pogliacomi F, De Filippo M, Paraskevopoulos A, Alesci M, Marenghi P, Ceccarelli F (2012) Mini-incision direct lateral approach versus anterior mini-invasive approach in total hip replacement: results 1 year after surgery. Acta Bio-medica Atenei Parmensis 83(2):114–121PubMed

41.

Ponzio DY, Poultsides LA, Salvatore A, Lee YY, Memtsoudis SG, Alexiades MM (2018) In-hospital morbidity and postoperative revisions after direct anterior vs posterior total hip arthroplasty. J Arthroplasty 33(5):1421–1425.e1421. https://doi.org/10.1016/j.arth.2017.11.053 CrossRefPubMed

42.

Putananon C, Tuchinda H, Arirachakaran A, Wongsak S, Narinsorasak T, Kongtharvonskul J (2018) Comparison of direct anterior, lateral, posterior and posterior-2 approaches in total hip arthroplasty: network meta-analysis. 28(2):255–267. https://doi.org/10.1007/s00590-017-2046-1

43.

Reichert JC, Volkmann MR, Koppmair M, Rackwitz L, Ludemann M, Rudert M, Noth U (2015) Comparative retrospective study of the direct anterior and transgluteal approaches for primary total hip arthroplasty. Int Orthop 39(12):2309–2313. https://doi.org/10.1007/s00264-015-2732-8 CrossRefPubMed

44.

Restrepo C, Parvizi J, Pour AE, Hozack WJ (2010) Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty 25(5):671–679.e671. https://doi.org/10.1016/j.arth.2010.02.002 CrossRefPubMed

45.

Rivera F, Leonardi F, Evangelista A, Pierannunzii L (2016) Risk of stem undersizing with direct anterior approach for total hip arthroplasty. Hip Int J Clin Exp Res Hip Pathol Therapy 26(3):249–253. https://doi.org/10.5301/hipint.5000337 CrossRef

46.

Rodriguez JA, Deshmukh AJ, Rathod PA, Greiz ML, Deshmane PP, Hepinstall MS, Ranawat AS (2014) Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach? Clin Orthop Relat Res 472(2):455–463. https://doi.org/10.1007/s11999-013-3231-0 CrossRefPubMed

47.

Sariali E, Catonne Y, Pascal-Moussellard H (2017) Three-dimensional planning-guided total hip arthroplasty through a minimally invasive direct anterior approach. Clinical outcomes at five years’ follow-up. Int Orthop 41(4):699–705. https://doi.org/10.1007/s00264-016-3242-z CrossRefPubMed

48.

Sendtner E, Borowiak K, Schuster T, Woerner M, Grifka J, Renkawitz T (2011) Tackling the learning curve: comparison between the anterior, minimally invasive (Micro-hip(R)) and the lateral, transgluteal (Bauer) approach for primary total hip replacement. Arch Orthop Trauma Surg 131(5):597–602. https://doi.org/10.1007/s00402-010-1174-4 CrossRefPubMed

49.

Shemesh SS, Robinson J, Keswani A, Bronson MJ, Moucha CS, Chen D (2017) The accuracy of digital templating for primary total hip arthroplasty: is there a difference between direct anterior and posterior approaches? J Arthroplasty 32(6):1884–1889. https://doi.org/10.1016/j.arth.2016.12.032 CrossRefPubMed

50.

Sheth D, Cafri G, Inacio MC, Paxton EW, Namba RS (2015) Anterior and anterolateral approaches for THA are associated with lower dislocation risk without higher revision risk. Clin Orthop Relat Res 473(11):3401–3408. https://doi.org/10.1007/s11999-015-4230-0 CrossRefPubMedPubMedCentral

51.

Simmonds MC, Higgins JP (2007) Covariate heterogeneity in meta-analysis: criteria for deciding between meta-regression and individual patient data. Stat Med 26(15):2982–2999. https://doi.org/10.1002/sim.2768 CrossRefPubMed

52.

Tamaki T, Jonishi K, Miura Y, Oinuma K, Shiratsuchi H (2018) Cementless tapered-wedge stem length affects the risk of periprosthetic femoral fractures in direct anterior total hip arthroplasty. J Arthroplasty 33(3):805–809. https://doi.org/10.1016/j.arth.2017.09.065 CrossRefPubMed

53.

Tamaki T, Oinuma K, Miura Y, Higashi H, Kaneyama R, Shiratsuchi H (2016) Epidemiology of dislocation following direct anterior total hip arthroplasty: a minimum 5-year follow-up study. J Arthroplasty 31(12):2886–2888. https://doi.org/10.1016/j.arth.2016.05.042 CrossRefPubMed

54.

Taunton MJ, Mason JB, Odum SM, Springer BD (2014) Direct anterior total hip arthroplasty yields more rapid voluntary cessation of all walking aids: a prospective, randomized clinical trial. J Arthroplasty 29(9 Suppl):169–172. https://doi.org/10.1016/j.arth.2014.03.051 CrossRefPubMed

55.

Thakkinstian A, McEvoy M, Minelli C, Gibson P, Hancox B, Duffy D, Thompson J, Hall I, Kaufman J, Leung TF, Helms PJ, Hakonarson H, Halpi E, Navon R, Attia J (2005) Systematic review and meta-analysis of the association between {beta}2-adrenoceptor polymorphisms and asthma: a HuGE review. Am J Epidemiol 162(3):201–211. https://doi.org/10.1093/aje/kwi184 CrossRefPubMed

56.

Thompson SG, Higgins JP (2002) How should meta-regression analyses be undertaken and interpreted? Stat Med 21(11):1559–1573. https://doi.org/10.1002/sim.1187 CrossRefPubMed

57.

Tsahtsarlis A, Wood M (2012) Minimally invasive transforaminal lumber interbody fusion and degenerative lumbar spine disease. Eur Spine J 21(11):2300–2305. https://doi.org/10.1007/s00586-012-2376-y CrossRefPubMedPubMedCentral

58.

Varin D, Lamontagne M, Beaule PE (2013) Does the anterior approach for THA provide closer-to-normal lower-limb motion? J Arthroplasty 28(8):1401–1407. https://doi.org/10.1016/j.arth.2012.11.018 CrossRefPubMed

59.

Watanabe K, Mitsui K, Usuda Y, Nemoto K (2019) An increase in the risk of excessive femoral anteversion for relatively younger age and types of femoral morphology in total hip arthroplasty with direct anterior approach. J Orthop Surg (Hong Kong) 27(2):2309499019836816. https://doi.org/10.1177/2309499019836816 CrossRef

60.

Wayne N, Stoewe R (2009) Primary total hip arthroplasty: a comparison of the lateral Hardinge approach to an anterior mini-invasive approach. Orthop Rev 1(2):e27. https://doi.org/10.4081/or.2009.e27 CrossRef

61.

Weale AE, Newman P, Ferguson IT, Bannister GC (1996) Nerve injury after posterior and direct lateral approaches for hip replacement. A clinical and electrophysiological study. J Bone Jt Surg Br 78(6):899–902CrossRef

62.

William B (2014) Response to “a tale of two approaches”: prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty 29(7):1507–1508. https://doi.org/10.1016/j.arth.2014.01.030 CrossRefPubMed

63.

Witzleb WC, Stephan L, Krummenauer F, Neuke A, Gunther KP (2009) Short-term outcome after posterior versus lateral surgical approach for total hip arthroplasty—a randomized clinical trial. Eur J Med Res 14(6):256–263CrossRef

64.

Yang C, Zhu Q, Han Y, Zhu J, Wang H, Cong R, Zhang D (2010) Minimally-invasive total hip arthroplasty will improve early postoperative outcomes: a prospective, randomized, controlled trial. Ir J Med Sci 179(2):285–290. https://doi.org/10.1007/s11845-009-0437-y CrossRefPubMed

65.

Zawadsky MW, Paulus MC, Murray PJ, Johansen MA (2014) Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases. J Arthroplasty 29(6):1256–1260. https://doi.org/10.1016/j.arth.2013.11.013 CrossRefPubMed

66.

Zhao HY, Kang PD, Xia YY, Shi XJ, Nie Y, Pei FX (2017) Comparison of early functional recovery after total hip arthroplasty using a direct anterior or posterolateral approach: a randomized controlled trial. J Arthroplasty 32(11):3421–3428. https://doi.org/10.1016/j.arth.2017.05.056 CrossRefPubMed

Titel: Comparative outcomes between collared versus collarless and short versus long stem of direct anterior approach total hip arthroplasty: a systematic review and indirect meta-analysis
verfasst von: Phonthakorn Panichkul
Suthorn Bavonratanavech
Alisara Arirachakaran
Jatupon Kongtharvonskul
Publikationsdatum: 30.07.2019
Verlag: Springer Paris
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 8/2019
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-019-02516-1

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Comparative outcomes between collared versus collarless and short versus long stem of direct anterior approach total hip arthroplasty: a systematic review and indirect meta-analysis