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

Abstract

Background: The purpose of this systematic review and meta-analysis was to compare the direct anterior approach and posterior approach for primary total hip arthroplasty in terms of the clinical, functional and radiographic outcomes. Methods: We searched the PubMed and EMBASE databases and Cochrane Library from their inception to November 1, 2019. We searched for previously published articles and meta-analyses of randomized controlled trials. Results: A total of 7 randomized controlled trials with 600 participants met the inclusion criteria. Among these patients, 301 and 299 were included in the DAA and PA groups, respectively. The DAA was associated with a longer surgery by a mean duration of 13.74 min (95% CI 6.88 to 20.61, p < 0.0001, I 2 = 93%). The postoperative early functional outcomes were significantly better in the DAA group than in the PA group, such as the Visual Analogue Scale (VAS) score at 1 day postoperatively (MD =-0.65, 95% CI − 0.91 to − 0.38, p < 0.00001, I 2 = 0%), VAS score at 2 days postoperatively (MD =-0.67, 95% CI − 1.34 to − 0.01, p = 0.05, I 2 = 88%) and Harris Hip Score (HHS) at 6 weeks postoperatively (MD = 6.05, 95% CI 1.14 to 10.95, p = 0.02, I 2 = 52%). There was no significant difference between the DAA and PA groups in the length of the incision, hospital length of stay (LOS), blood loss, transfusion rates or complication rates. We found no significant difference between the two groups regarding late functional outcomes, such as the VAS score at 12 months postoperatively or the HHS scores at 3, 6, and 12 months postoperatively. A significant difference in the radiographic outcomes was not detected.

MRI Assessment of Muscle Damage After the Posterolateral Versus Direct Anterior Approach for THA (Polada Trial). A Randomized Controlled Trial

“…Although the confidence interval of our interobserver variation for stem alignment was large, the difference in degrees was low and not clinically relevant. Comparable results were seen in the study by Lin et al [64] However, no differences were seen in another randomized trial and two recent meta-analyses and desired angles can be achieved in both approaches [11,12,65]. We observed two patients with a dislocation, one in each group.…”

Preoperative ultrasound to map the three-dimensional anatomical distribution of the lateral femoral cutaneous nerve in direct anterior approach for total hip arthroplasty

“…The main reasons that result in LFCN injury include two aspects: ① the anatomical variations and frequent branches of LFCN; ② the DAA approach close to the path of LFCN. In the proximal femur, LFCN courses the intermuscular space between the TFL and sartorius muscles, which is also the surgical field [ 17 , 24 , 25 ]. These two factors increase the risk of cutting or suturing of LFCN interoperation, which are the main reasons for LFCN injury.…”

Patient-reported results of simultaneous direct anterior approach and posterolateral approach total hip arthroplasties performed in the same patients

“…This study demonstrates a longer operative time and shorter length of incision for DAA-THA compared with PLA-THA. Recently, two literature reviews showed that DAA requires a longer operative time than PLA in THA [ 27 , 28 ]. We believe that the prolonged operative time in DAA is mainly related to the difficulty of proximal femur exposure because of the need for gradual release, exposure, and the additional steps, all of which result in a longer operative time in DAA than in PLA.…”