Direct anterior approach versus posterolateral approach for total hip arthroplasty in the treatment of femoral neck fractures in elderly patients: a meta-analysis and systematic review

Abstract

Objective The purpose of this meta-analysis was to evaluate the postoperative clinical outcomes of elderly patients who underwent the direct anterior approach (DAA) versus those who received posterolateral approach (PLA) for total hip arthroplasty (THA) in the treatment of femoral neck fractures. Methods An electronic search was conducted in databases including PubMed, Embase, Web of Science, the Cochrane Library, and CNKI from their inception to January 2022. We calculated the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to assess the effect of DAA compared to PLA for the management of total hip arthroplasty (THA) in elderly patients using the dichotomous or continuous method with a random or fixed-effect model. Results 15 studies involving 1284 patients were included; 640 patients receiving DAA and 644 patients receiving PLA. DAA had a longer surgery duration than PLA [WMD = 9.41, 95% CI (4.64, 14.19), I 2 =95.5%]; The amount of postoperative drainage [WMD= −3.88, 95% CI (−5.59, −2.17), I 2 =98.3%], length of incision [WMD= −3.88, 95% CI (−5.59, −2.17), I 2 =98.3%], blood loss [WMD= −3.88, 95% CI (−5.59, −2.17), I 2 =98.3%], hospitalization time [WMD= −3.88, 95% CI (−5.59, −2.17), I 2 =98.3%], and postoperative bedtime [WMD = −5.56,95% CI (−7.11, −4.01), I 2 =99.0%], were similar between the two groups ( p < 0.05). The HHS at 1 month, 12 months postoperatively [WMD = 7.58, 95%CI (5.70,9.46), I 2 =89.5%; WMD= 2.56, 95%CI 0.11,5.00, I 2 =93.2%] and the incidence of LFCN in patients were higher in the DAA group (OR = 2.91, 95% CI 1.26 to 6.71, I 2 =0.0%), while fewer patients in the DAA group suffered from postoperative dislocation than in the PLA group (OR = 0.26, 95% CI 0.11 to 0.60, I 2 =0.0%). No significant difference was observed in HHS at 1 week, 3 months, and 6 months postoperatively, VAS postoperatively at each time point, acetabular anteversion angle, acetabular abduction angle, wound infection, deep vein thrombosis, and intraoperative fracture ( p > 0.05). Conclusions DAA offers a quicker functional recovery and is less invasive with an earlier return to daily activities in older THA patients than PLA. However, DAA was found to be associated with a high incidence of lateral femoral cutaneous nerve injury and a low incidence of postoperative dislocation. Key messages The present study aims to evaluate the clinical outcomes in elderly patients recei...

Direct anterior approach with conventional instruments versus robotic posterolateral approach in elective total hip replacement for primary osteoarthritis: a case–control study

“…Historically, the DAA was considered to be less painful than the posterolateral approach [ 15 , 16 ] but available studies do not report comparative results of robotic arm-assisted surgery. The current research addressed potential confounders related to sample populations (i.e.…”

Does intraoperative fluoroscopy improve acetabular component positioning and limb-length discrepancy during direct anterior total hip arthroplasty? A meta-analysis

“…Recent years have seen an upsurge in using the direct anterior approach (DAA) for THA [ 26 ]. The approach is said to have a variety of advantages, according to its proponents, including a slight advantage in early recovery [ 27 ], a low dislocation rate [ 28 ], and excellent radiographic component placement parameters [ 29 ]. The DAA’s ability to capture intraoperative fluoroscopic pictures while the patient is supine for implant placement is another advantage [ 30 , 31 ].…”

Dementia and Hip Fractures

“…The direct anterior approach is increasing in popularity and is considered inherently stable. When comparing the direct anterior approach with the posterolateral approach for THA performed for dFNF, the direct anterior approach resulted in fewer postoperative dislocations 58 . This approach should be considered by surgeons who are facile with this technique.…”