Effectiveness and safety of the posterior approach with soft tissue repair for primary total hip arthroplasty: a meta-analysis.

BACKGROUND: Repair of soft tissue in favour of the posterior approach for total hip arthroplasty is still under discussion and few studies are assessing this issue. Therefore, we performed a meta-analysis to compare the effectiveness and safety of the posterior approach for total hip arthroplasty with and without soft tissue repair. We focused on these questions as follows: does primary posterior approach for total hip arthroplasty with soft tissue repair has better result regarding dislocation rate, Harris hip score and the sciatic nerve palsy rate compared with posterior approach without soft tissue repair. PATIENTS AND METHODS: We conducted electronic literature searches using CENTRAL (Issue 1 of 12, Jan 2014), PUBMED (1980 to Jan 2014), and EMBASE (1980 to Jan 2014). Clinical studies evaluating the posterior approach for total hip arthroplasty with and without soft tissue repair were collected. After independent study selection by 2 authors, data were collected and extracted independently. The methodological quality of the studies was assessed by the Cochrane Collaboration's tool for assessing risk of bias and the Newcastle-Ottawa Scale. RESULT: Seven clinical trials with 4594 hips using the posterior approach for total hip arthroplasty were included. The pooled data indicated a lower rate of dislocation (OR: 0.14, 95% CI: 0.08-0.26, P<0.00001) and higher Harris hip score (1.75, 95% CI: 1.19 to 2.32, P<0.00001, I(2)=26%) after the posterior approach to total hip arthroplasty using soft tissue repair than without using soft tissue repair. There was no statistical difference in sciatic nerve palsy between the use of soft tissue repair and without it in posterior approach to total hip arthroplasty (OR: 5.34, 95% CI: 0.25-112.25, P=0.28). DISCUSSION: Our meta-analysis included data from more studies than were previously available and demonstrated that the use of soft tissue repair and without it in posterior approach to total hip arthroplasty are similar in safety. Using repair resulted in a lower dislocation rate and higher Harris hip score than without repair. LEVELS OF EVIDENCE: Level 2 meta-analysis of low-powered prospective randomised trial.