Chinese clinical practice guidelines for total hip arthroplasty approach selection (2021 edition)

doi:10.3877/cma.j.issn.1674-134X.2021.06.001

Abstract

Abstract:

Total hip arthroplasty (THA) is a major procedure that plays an important role in relieving pain and restoring function in end-stage hip related diseases, and the number of THA procedures continues to grow at a high rate. Unfortunately, there is no guideline or expert consensus on the choice of THA approach in China or abroad. Therefore, to formulate the clinical practice guidelines for THA approach selection based on evidence-based medicine is of major importance. The guidelines were developed by the Joint Surgery Group of the Orthopaedic Branch of the Chinese Medical Association and Chinese Journal of Joint Surgery (Electronic Edition) and were designed and developed in accordance with the World Health Organization Manual for the Development of Guidelines and the Basic Methods and Procedures for the Development/Revision of Clinical Guidelines. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist were adopted. Finally, 11 clinical questions were selected, resulting in 11 evidence-based medical recommendations. The guidelines are intended to guide the clinical practice of a wide range of relevant healthcare professionals in relation to surgical approach selection and to normative guidelines for a good prognosis for patients with THA.

Key words: Arthroplasty, replacement, hip, Evidence-based medicine

The Joint Surgery Branch of the Chinese Orthopaedic Association, 920th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army. Chinese clinical practice guidelines for total hip arthroplasty approach selection (2021 edition)[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(06): 651-659.

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References 61

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证据质量分级	定义
高(A)	非常有把握观察值接近真实值
中(B)	对观察值有中等把握：观察值有可能接近真实值，但也有可能差别很大
低(C)	对观察值的把握有限：观察值可能与真实值有很大差别
极低(D)	对观察值几乎没有把握：观察值与真实值可能有极大差别

证据质量分级	定义
高(A)	非常有把握观察值接近真实值
中(B)	对观察值有中等把握：观察值有可能接近真实值，但也有可能差别很大
低(C)	对观察值的把握有限：观察值可能与真实值有很大差别
极低(D)	对观察值几乎没有把握：观察值与真实值可能有极大差别

推荐强度分级	定义
强推荐(1)	明确显示干预措施利大于弊
弱推荐(2)	利弊不确定或干预措施可能利大于弊

推荐强度分级	定义
强推荐(1)	明确显示干预措施利大于弊
弱推荐(2)	利弊不确定或干预措施可能利大于弊

序号	推荐意见	推荐强度与证据质量
1	建议临床医师以患者获得最优手术结局为原则，参考多方面因素，在权衡利弊后对手术入路进行选择。	1C
2	建议临床医师考虑临床情境，针对原发疾病的病理学及解剖学特点，选择适宜的手术入路。	2D
3	在开展人工髋关节置换手术时，推荐临床医师参考个人习惯或偏好对手术入路进行选择。	1D
4	建议临床医师不要将他人的入路选择习惯或建议作为自己入路选择的主要参考依据。	2D
5	建议临床医师不要将假体类型作为入路选择的参考依据之一。	2D
6	推荐临床医师以充分显露为前提进行手术入路的选择决策。	1D
7	建议临床医师在考虑患者自身与疾病特征以及手术经验后，在功能获益相当的前提下，选择手术入路。	2C
8	基于现有的证据，尚不确定哪个入路更有利于假体安放。	D
9	为实现快速康复，推荐临床医师选择小切口经肌间隙入路。	1C
10	推荐临床医师选择经肌间隙入路以减少软组织损伤。	1C
11	基于现有的证据，尚不确定入路选择是否与术后远期疗效有关。	D

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