Direct anterior versus posterolateral approaches for clinical outcomes after total hip arthroplasty: a systematic review
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(2020) 15:231
SYSTEMATIC REVIEW
Open Access
Direct anterior versus posterolateral approaches for clinical outcomes after total hip arthroplasty: a systematic review and meta-analysis Wang Chen, Jian-Ning Sun, Ye Zhang, Yu Zhang, Xiang-Yang Chen*
and Shuo Feng*
Abstract Objective: The main objective of our study was to compare the intraoperative and postoperative outcomes of direct anterior approach (DAA) with posterolateral approaches (PLA). Methods: We searched Cochrane library, Web of Science, and PubMed for literatures comparing DAA with PLA. On the basis of inclusion and exclusion criteria, relevant literatures were selected. Two members independently screened qualified literatures, evaluated the literature quality, and extracted data information. Results: Eighteen randomized controlled trials (RCTs) and non-RCTs totaling 34,873 patients (DAA = 9636, PLA = 25237) were contained in this systematic review and meta-analysis. The results showed that DAA were reduced in terms of length of hospital stay (weighted mean difference (WMD) = −0.43, 95% confidence interval (CI) −0.78 to −0.09, P = 0.01), LLD (WMD = −2.00, 95% CI −2.75 to −1.25, P < 0.00001), PE/DVT (WMD = 0.36, 95% CI 0.15 to 0.85, P = 0.02), dislocation (WMD = 0.42, 95% CI 0.30 to 0.59, P < 0.00001) and visual analog scale (VAS) (WMD = −0.57, 95% CI −0.91 to −0.23, P = 0.0009) compared with PLA; however, DAA compared with the PLA was increasing in terms of operative time (WMD = 14.81, 95% CI 7.18 to 22.44, P = 0.0001), intraoperative blood loss (WMD = 105.13, 95% CI 25.35 to 184.90, P = 0.01), fracture (WMD = 1.46, 95% CI 1.00 to 2.11, P = 0.05), and Harris hip score (HHS) (WMD = 1.19, 95% CI 0.77 to 1.61, P < 0.00001). Conclusions: DAA was preferable effectiveness to PLA in early pain relief and functional recovery; however, PLA has a shorter operation time, intraoperative less blood loss and fracture. Trial registration: Registration ID, CRD42020151208 Keywords: Total hip arthroplasty, Direct anterior approach, Posterolateral approach
Introduction Total hip arthroplasty (THA) is a valid method for the treatment of hip diseases such as femoral neck fracture, aseptic necrosis of femoral head, developmental hip dysplasia, and rheumatoid arthritis [1]. It can significantly eliminate the patients’ hip pain, restore hip function, get * Correspondence: [email protected]; [email protected] Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou 221002, Jiangsu, China
rid of pain, and improve the quality of life [2]. During the 10-year follow-up, the clinical efficacy of THA has been significantly improved and the survival rate of the prosthesis exceeded 95% [3]. There are various approaches for THA: anterolateral approach (ALA), posterolateral approaches (PLA), direct anterior approach (DAA), direct lateral approach (DLA), etc. ALA is performed via the gluteus medius, vastus lateralis, and external rotators [4]. Static Trendelenburg
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