Comparison of Postoperative Serum Biomarkers after Total Hip Arthroplasty through Minimally Invasive versus Conventional Approaches: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background: An effective way to objectively assess intraoperative tissue damage in total hip arthroplasty (THA) is to determine and compare postoperative serum biomarkers (laboratory parameters) such as creatine kinase (CK), C-reactive protein (CRP), and hemoglobin (Hb). This meta-analysis aims to compare the intraoperative tissue damage in THA through minimally invasive (MI) and conventional approaches (CAs) using postoperative serum biomarkers. Methods: We searched databases for randomized controlled trials (RCTs) comparing MI THA and CA THA. We calculated mean differences (MDs) with 95% confidence intervals (CIs) for continuous outcomes, using the Hartung–Knapp–Sidik–Jonkman method and a common effect/random effects model. Results: A total of 13 RCTs, involving 1186 THA patients, were included in our meta-analysis. In two out of eleven examined outcome parameters, MI THA showed better results than CA THA. In nine out of eleven examined outcome parameters, MI THA showed no significant difference compared to CA THA. MI THA had a 16 mg/L lower CRP value 3 days postoperatively than CA THA (I2 = 66%, p = 0.03, MD = −15.65, 95% CI −30.10 to −1.21). MI THA had a 3 mg/L lower CRP value 4 days postoperatively than CA THA (I2 = 0%, p = 0.98, MD = −3.00, 95% CI −3.27 to −2.74). Conclusions: Overall, there was no significant difference between MI THA and CA THA in terms of postoperative serum biomarkers, with a slight advantage of MI THA in CRP values. These results do not provide sufficient evidence to recommend changing the surgical approach from CA THA to MI THA. Level of evidence I: a systematic review of all relevant randomized controlled trials.