Indirect comparison in network meta-analysis between SuperPATH, direct anterior and conventional approach hemiarthroplasty in patients with femoral neck fracture

Abstract

Background: The aim of the study was to compare the short-term outcome of SuperPATH, direct anterior (DAA) and conventional approach (CA) hemiarthroplasty (HA) in patients with femoral neck fractures using a network meta-analysis. Methods: PubMed, China National Knowledge Infrastructure, Epistemonikos, and Embase were searched until May 31, 2024. In a network meta-analysis, mean differences with 95% confidence intervals were calculated using the Hartung–Knapp–Sidik–Jonkman method and a fixed/random effects model for continuous outcomes, and odds ratios with 95% confidence intervals were calculated using the Mantel–Haenszel method and a fixed/random effects model for dichotomous outcomes. Results: The literature search identified a total of 9 randomized controlled trials on SuperPATH with 762 patients and 8 randomized controlled trials on DAA with 641 patients. In the overall ranking, SuperPATH was placed first, DAA second and CA third. SuperPATH HA was best in 7, second best in 2 and third best in 1 of the 10 outcome parameters. DAA HA was best in 2 and second best in 8 of the 10 outcome parameters. CA HA was best in 1 and third best in 9 of the 10 outcome parameters. In the indirect comparison between SuperPATH HA and DAA HA, SuperPATH HA had a 1.36 point lower visual analog scale at 2 to 7 days postoperatively and a 0.17 lower overall complication rate compared to DAA. Conclusion: For the treatment of patients with femoral neck fractures, SuperPATH HA ranked first, DAA HA ranked second and CA HA ranked third. Based on the results, we recommend that trauma surgeons increase their use of minimally invasive hip HA techniques. It should be noted that SuperPATH HA had a significantly lower overall complication rate compared to DAA HA when the minimally invasive technique was chosen. Abbreviations: CA = conventional approach, CI = confidence interval, DAA = direct anterior approach, HA = hemiarthroplast, HHS = Harris Hip Score, RCT = randomized controlled trialSUCRA = surface under the cumulative ranking curve, THA = total hip arthroplasty, VAS = visual analog scale.