Prone or lateral patient positioning in KocherLangenbeck approach in acetabular fractures fixation: A systematic review and meta-analysis

Abstract

The Kocher-Langenbeck (K-L) approach is the approach of choice to treat fractures involving the posterior acetabulum. It provides direct exposure to the acetabulum, adequate reduction, and access to treat associated hip fractures. However, there is no consensus on the positioning of the patient; prone or lateral. This review aimed to investigate the effect of patient positioning on the outcomes of the K-L approach in acetabular fracture fixation. Cochrane, Web of Science, Google Scholar, and PubMed were searched from inception until February 22, 2022. Inclusion criteria encompassed studies that investigated acetabular fracture fixation utilizing the K-L approach in relation to patient positioning (Prone and/or Lateral). Only English manuscripts that reported at least one of the outcomes of interest were included in the study. Studies that utilized both positions without specifying the outcomes in relation to the patient position were excluded from the study. The Newcastle–Ottawa Scale and the Joanna Briggs Institute tool were utilized to assess the quality of the included studies. This study included 521 patients from six articles. Of those patients, 46.1% were operated on in the lateral position and 53.9% in the prone position. The mean operative time of lateral and prone positions was 160.9 min (95% confidence intervals [CI]: 135.11–186.64) and 212.5 min (95% CI: 167.08–257.94), respectively. The mean blood loss in the lateral position was 502.mL (95% CI: 471.61–532.47) compared to 482.5 mL (95% CI: 396.77–568.28) in the prone position. The pooled complications in the lateral position were 29% (95% CI: 19–39%) compared to 37% (95% CI: 6–75%) in the prone position. The outcomes did not significantly differ when comparing lateral and prone patient positioning for posterior acetabular fracture fixation through the K-L approach. Further prospective randomized controlled studies are recommended to reach the best evidence.