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. 2023 Jun 8;8(6):443-450.
doi: 10.1530/EOR-22-0108.

A systematic review comparing the cost-effectiveness of the direct anterior, posterior, and straight lateral approach in total hip arthroplasty

Julia E J W Geilen  1 , Sem M M Hermans  1   2 , Ruud Droeghaag  1   2 , Martijn G M Schotanus  1   2 , Emil H van Haaren  1 , Wouter L W van Hemert  1
Affiliations

A systematic review comparing the cost-effectiveness of the direct anterior, posterior, and straight lateral approach in total hip arthroplasty

Julia E J W Geilen et al. EFORT Open Rev. .

Abstract

Background: Total hip arthroplasty is a reliable option to treat osteoarthritis. It reduces pain, increases quality of life, and restores function. The direct anterior approach (DAA), posterior approach (PA), and straight lateral approach (SLA) are mostly used. This systematic review evaluates current literature about costs and cost-effectiveness of DAA, PA, and SLA.

Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic search, registered in the PROSPERO database (registration number: CRD42021237427), was conducted of databases PubMed, CINAHL, EMBASE, Cochrane, Clinical Trials, Current Controlled Trials, ClinicalTrials.gov, NHS Centre for Review and Dissemination, Econlit, and Web of Science. Eligible studies were randomized controlled trials (RCTs) or comparative cohort studies reporting or comparing costs or cost-effectiveness of either approach as the primary outcome. The risk of bias (RoB) was assessed. For comparison, all costs were converted to American Dollars (reference year 2016).

Results: Six systematic review studies were included. RoB ranged from low to high, the level of evidence ranged from 2 to 4, and methodological quality was moderate. Costs ranged from $5313.85 to $15 859.00 (direct) and $1921.00 to $6364.30 (indirect) in DAA. From $5158.46 to $12 344.47 (direct) to $2265.70 to $5566.01 (indirect) for PA and from $3265.62 to $8501.81 (direct) and $2280.16 (indirect) for SLA. Due to heterogeneity of included costs, they were not directly comparable. Solid data about cost-effectiveness cannot be presented.

Conclusions: Due to limited and heterogenous evidence about costs and cost-effectiveness, the effect of these in surgical approach is unknown. Further well-powered research to make undisputed conclusions is needed.

Keywords: cost-effectiveness; costs; direct anterior approach; posterior approach; straight lateral approach; total hip arthroplasty.

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Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
Risk of bias of the included randomized controlled trials.
See this image and copyright information in PMC

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