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 clinical, functional and radiographic outcomes of primary total hip arthroplasty between the direct anterior approach and posterior approach. Methods: We searched the PubMed, EMBASE databases and Cochrane library from the inception dates to November 1, 2019. And we also searched for the meta-analysis which was published in the past for randomized controlled trials. Results: A total of 7 randomized controlled trials with 600 participants fulfilled the inclusion criteria. Among these, 301 and 299 patients were in the DAA and PA groups, respectively. DAA was associated with a longer surgery time by a mean of 13.74 min (95% CI 6.88 to 20.61, p < 0.0001, I2=93%). Postoperative early functional outcomes were significantly better in the DAA group than PA group such as Visual Analogue Scale (VAS) postoperative 1 day (MD=-0.65, 95% CI -0.91 to -0.38,p < 0.00001, I2=0%), VAS score postoperative 2 days (MD=-0.67, 95% CI -1.34 to -0.01, p =0.05,I2=88%) and Harris Hip Score (HHS) postoperative 6 weeks(MD=6.05, 95% CI 1.14 to 10.95, p =0.02, I2=52%).There was no significant difference between the DAA and PA groups at length of incision, length of stay(LOS), blood loss, transfusion rates or complication rates. We found no significant difference between the two groups about late functional outcomes such as VAS score postoperative 12 months or HHS scores postoperative 3, 6, 12 months. A significant difference in Radiographic outcomes can not be detected too. Conclusions: DAA needs longer surgery time than PA in primary total hip arthroplasty. The DAA offers better early functional recovery than PA. There is no significant difference between the two groups in terms of other clinical, complication, late functional and radiographic outcomes. The evidence about the superiority of DAA is insufficient, which needs more research.