A systematic review and meta-analysis of direct anterior approach versus posterior approach in total hip arthroplasty
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SYSTEMATIC REVIEW
Open Access
A systematic review and meta-analysis of direct anterior approach versus posterior approach in total hip arthroplasty Zhao Wang, Jing-zhao Hou, Can-hua Wu, Yue-jiang Zhou, Xiao-ming Gu, Hai-hong Wang, Wu Feng, Yan-xiao Cheng, Xia Sheng and Hong-wei Bao*
Abstract Background: This meta-analysis aimed to evaluate the postoperative clinical outcomes and safety of the direct anterior approach (DAA) versus posterior approach (PA) in total hip arthroplasty (THA). Methods: We searched PubMed, Embase, Web of Science, the Cochrane Library, and Google databases from inception to June 2018 to select studies that compared the DAA and PA for THA. Only randomized controlled trials (RCTs) were included. Outcomes included Harris hip score at 2 weeks, 6 weeks, 12 weeks, and 1 year; VAS at 24 h, 48 h, and 72 h; incision length, operation time, postoperative blood loss, length of hospital stay, and complications (intraoperative fracture, postoperative dislocation, heterotopic ossification (HO), and groin pain). Results: Nine RCTs totaling 754 THAs (DAA group = 377, PA group = 377) met the criteria to be included in this metaanalysis. The present meta-analysis indicated that, compared with PA group, DAA group was associated with an increase of the Harris hip score at the 2-week and 4-week time points. No significant difference was found between DAA and PA groups of the Harris hip scores at 12 weeks, 1 year length of hospital stay (p > 0.05). DAA group was associated with a reduction of the VAS at 24 h, 48 h, and 72 h with statistical significance (p < 0.05). What is more, DAA was associated with a reduction of the incision length and postoperative blood loss (p < 0.05). There was no significant difference between the operation time and complications (intraoperative fracture, postoperative dislocation, HO, and groin pain). Conclusion: In THA patients, compared with PA, DAA was associated with an early functional recovery and less pain scores. What is more, DAA was associated with shorter incision length and blood loss. Keywords: Direct anterior approach, Posterior approach, Total hip arthroplasty, Meta-analysis
Introduction Total hip arthroplasty (THA) is an effective surgery alternative for patients with hip osteoarthritis (OA) or femoral head necrosis [1, 2]. Kurtz et al. [3] reported a 50% increase in the prevalence of THA from 1990 to 2002 and estimated nearly 572,000 THAs in 2030. Most THA patients experience pain relief, improved function, and restoration of quality of life [4]. However, nearly 7– 15% patients were dissatisfied with THA due to the postoperative pain and functional recovery [5, 6]. The potential causes of postoperative pain include failure of fixation and * Correspondence: [email protected] From the department of orthopaedics, Jingjiang People’s Hospital, 28 No, Zhongzhou Road, Jingjiang, Taizhou City 214500, Jiangsu Province, China
damage of soft tissues [7]. Among the causes of damage of soft tissues, surgical approach was one of the influential factors [8, 9]. Choosing the
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