Direct Anterior Approach Versus Posterolateral Approach in Total Hip Arthroplasty: A Systematic Review and Meta‐analysis of Randomized Controlled Studies

Abstract

Objective To compare the early rehabilitation effects of total hip arthroplasty (THA) with the direct anterior approach (DAA) versus the posterior approach (PA). Methods We searched PubMed, Embase, Web of Science, the Cochrane Library, and Google databases from inception to June 2019 to select studies that compared the DAA and PA for THA. Only randomized controlled trials (RCT) were included. Two researchers independently screened studies for inclusion, extracted data, and assessed the methodological quality. A meta‐analysis was conducted using RevMan 5.3 software provided by Cochrane Assisted Network. Results A total of 932 patients underwent THA. There were 467 cases in group DAA and 465 cases in group PA. There was a significant difference in the incidence of lateral femoral cutaneous nerve injury between DAA and PA groups (RR = 38.97, 95% CI: 7.89–192.57, P < 0.05). DAA was associated with less pain compared with PA [WMD = −0.65, 95% CI (−0.91–0.38), P < 0.05]. There was no significant difference in operation time, hospitalization stay, and intraoperative bleeding volume. Moreover, in supplementary data, the number of acetabular prostheses in Lewinnek's safety zones in DAA was more than that in the PA group (RR = 1.20, 95% CI [1.04–1.39], P < 0.05), and the time of discontinuation of walking aids in the DAA group was earlier than that in the PA group (WMD = −11.05, 95% CI [−17.79–4.31], P < 0.05). Conclusion The DAA total hip arthroplasty has comparable results with PA, with earlier postoperative functional recovery, less postoperative pain scores, and higher incidence of lateral femoral cutaneous nerve injury. The results need to be validated by large‐sample, high‐quality RCT studies, and long‐term follow‐up of complications.

Randomized Clinical Study on the Efficacy of Direct Anterior Approach Combined With Tendon Release and Repair After Total Hip Arthroplasty

“…In recent years, with the continuous development of minimally invasive techniques, there have been more methods of the THA surgical approach. Among them, the direct anterior approach (DAA) is a new minimally invasive surgical technique that is currently widely available and clinically applied in total hip arthroplasty ( 30 ). This technology uses the muscle gap between the tensor fascia lata and sartorius muscles as well as the rectus and gluteus medius muscles to expose the hip joint, hence, avoiding damage to the abductor muscles around the hip joint and ensuring the integrity of the soft tissues on the back of the hip joint.…”

Risk factors for femoral fracture in lateral decubitus direct anterior approach total hip arthroplasty using conventional stems: a retrospective analysis

“…Compared with Europeans and Americans, Chinese individuals are relatively short [ 25 , 26 ], which increases the difficulty of femoral exposure and the operation. Yang et al [ 27 ] reported increasing difficulty performing the operation with shorter femoral necks. In this study, the ASIS-GTD was measured in the standard pelvic position, which was very simple.…”

Risk Factors of Femoral Fractures in Lateral Decubitus Direct Anterior Approach Total Hip Arthroplasty Using Conventional Stem: A Retrospective Analysis

“…Compared with Europeans and Americans, Chinese are relatively short [25][26], which made femoral exposure and operation more di cult. Shang Xifu et al [27] reported that the di culty of DAA surgery in patients with short femoral neck increased, and the quanti cation of femoral neck was complicated. In this study, ASIS-GTD was measured on the standard pelvic position, which was very simple.…”