The role of patient surgical positioning on hip arthroplasty component placement and clinical outcomes: a systematic review and meta-analysis

Total Hip Arthroplasty (THA) may be performed through various approaches; however, depending on the surgical position of the patient, the superiority of lateral or supine position is still debated. The aim of this systematic review and meta-analysis was to compare the supine versus lateral position in THA in terms of intraoperative and postoperative outcomes and component placement. The systematic literature search was performed by the use of Cochrane Central, Pub-Med-Medline, and Google Scholar in order to select studies that evaluated clinical outcomes and the outliers of cup alignment for inclination and anteversion between supine and lateral position for hip arthroplasty. Finally, 9 articles were included in this review. The meta-analysis showed no significant differences between the two groups for clinical outcomes, unless for blood loss and VAS (respectively p = 0.05 and p = 0.004 in favour of lateral decubitus). Regarding the number of outliers, the supine decubitus showed significant differences only for the cup anteversion (p = 0.01). However, more prospective studies with a longer follow-up that analyze both clinical and radiological parameters are needed to assess the superiority of supine or lateral patient position for total hip arthroplasty.