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

Linbo Peng,Yuangang Wu,Bin Shen,Yuan Liu,Junfeng Zeng,Yi Zeng

doi:10.1186/s12891-020-03318-x

Linbo Peng, Yuangang Wu + Show 4 more

Open Access

https://doi.org/10.1186/s12891-020-03318-x

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Abstract

BackgroundThe 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.MethodsWe 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.ResultsA 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, I2 = 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, I2 = 0%), VAS score at 2 days postoperatively (MD = -0.67, 95% CI − 1.34 to − 0.01, p = 0.05, I2 = 88%) and Harris Hip Score (HHS) at 6 weeks postoperatively (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 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.ConclusionsThe DAA requires a longer surgery time than does the PA in primary total hip arthroplasty. The DAA yields better early functional recovery than does the PA. There was no significant difference between the two groups in terms of other clinical, complication-related, late functional or radiographic outcomes. The evidence on the superiority of the DAA is insufficient and needs to be studied further.

Highlights

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
There was no significant difference between the two groups in terms of other clinical, complication-related, late functional or radiographic outcomes
There was no significant difference between the two groups in terms of the preoperative Visual Analogue Scale (VAS) score (MD = -0.08, 95% Confidence interval (CI) − 0.41 to 0.25, p = 0.62, I2 = 42%, Fig. 14)

Summary

Introduction

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. Many surgical approaches are used in THA surgery, but there is little evidence indicating which approach has the most advantages [5, 6]. The direct anterior approach (DAA) is considered a true minimally invasive approach because it leads to a small amount of muscle damage, as the operation is performed through a small incision and a muscle interval in the hip joint [7, 8]. The conventional posterior approach (PA) is the most frequently used surgical approach for THA [9]

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