A systematic review and meta-analysis of direct anterior approach versus posterior approach in total hip arthroplasty

Abstract

BackgroundThis meta-analysis aimed to evaluate the postoperative clinical outcomes and safety of the direct anterior approach (DAA) versus posterior approach (PA) in total hip arthroplasty (THA).MethodsWe searched PubMed, Embase, Web of Science, the Cochrane Library, and Google databases from inception to June 2018 to select studies that compared the DAA and PA for THA. Only randomized controlled trials (RCTs) were included. Outcomes included Harris hip score at 2 weeks, 6 weeks, 12 weeks, and 1 year; VAS at 24 h, 48 h, and 72 h; incision length, operation time, postoperative blood loss, length of hospital stay, and complications (intraoperative fracture, postoperative dislocation, heterotopic ossification (HO), and groin pain).ResultsNine RCTs totaling 754 THAs (DAA group = 377, PA group = 377) met the criteria to be included in this meta-analysis. The present meta-analysis indicated that, compared with PA group, DAA group was associated with an increase of the Harris hip score at the 2-week and 4-week time points. No significant difference was found between DAA and PA groups of the Harris hip scores at 12 weeks, 1 year length of hospital stay (p > 0.05). DAA group was associated with a reduction of the VAS at 24 h, 48 h, and 72 h with statistical significance (p < 0.05). What is more, DAA was associated with a reduction of the incision length and postoperative blood loss (p < 0.05). There was no significant difference between the operation time and complications (intraoperative fracture, postoperative dislocation, HO, and groin pain).ConclusionIn THA patients, compared with PA, DAA was associated with an early functional recovery and less pain scores. What is more, DAA was associated with shorter incision length and blood loss.

Clinical, functional and radiographic outcomes of primary total hip arthroplasty between direct anterior approach and posterior approach: a systematic review and meta-analysis

“…Retrospective studies and nonrandomized controlled trials are included in most of the meta-analyses, which leads to indirect evidence [21][22][23]. Nonstandard approaches such as piriformis preserving approaches and those involving computer-aided technology were inappropriately regarded as standard approaches in some studies [21][22][23][24][25], which should be strictly avoided for accurate results. Therefore, we performed a meta-analysis with strict inclusion criteria and includes the most recently published RCTs to compare the direct anterior approach and posterior approach for primary total hip arthroplasty in terms of the clinical, functional and radiographic outcomes.…”

Clinical, Functional and Radiographic Outcomes of Primary Total Hip Arthroplasty between Direct Anterior Approach and Posterior Approach: a Systematic Review and Meta-analysis

“…In our study, early functional outcomes, such as the VAS score at 1 day postoperatively, VAS score at 2 days postoperatively and HHS at 6 weeks postoperatively, were significantly better in the DAA group than in the PA group. Some other studies [21,22,25] also showed better early functional outcomes and lower pain scores in the DAA group. Our findings support this conclusion and increase the level of evidence.…”

“…Wang et al [25] reported a significantly shorter incision length and significantly less postoperative blood loss in the DAA group than in the PA group. They also found no significant difference in the operation time or rate of complications between the two groups.…”

“…Retrospective studies and non-randomized controlled trials are included in most of the meta-analyses, which leads to indirect evidence [21][22][23] . Nonstandard approaches such as piriformis preserving approaches and those involving computer-aided technology were inappropriately regarded as standard approaches in some studies [21][22][23][24][25] , which should be strictly avoided for accurate results. Therefore, we performed a meta-analysis with strict inclusion criteria and includes the most recently published RCTs to compare the direct anterior approach and posterior approach for primary total hip arthroplasty in terms of the clinical, functional and radiographic outcomes.…”

Early surgical complications of total hip arthroplasty related to surgical approach

“…There is some controversy as to whether surgical complications differ between approaches. [14][15][16] Although International registries have reported on surgical approach, 6,8,9,17 they have largely focused on revision procedures rather than other complications that may necessitate return to theatre, which tend to be underreported. It is only with large volume, long term, multi-surgeon in-depth data collection that the complications and benefits of each THA approach can be determined and compared.…”