A Comparison Of Clinical Outcomes After Total Hip Arthroplasty Between Direct Anterior Approach And Posterior Approach:a Systematic Review And Meta-analysis

Objective:Systematic review and meta-analysis were used to directly evaluate direct anterior approach and posterior approach for early efficacy and safety of total hip arthroplasty(THA).Methods:Controlled trials assessing DAA and PA for efficacy and safety of THA were searched in the database.Articles were reviewed according to predetermined inclusion and exclusion criteria;quality of methodologies included in a given study was strictly assessed before data extraction.Moreover,meta-analysis was performed for outcomes that can be combined;otherwise,descriptive analysis was performed.Results:There were 20 articles included,with a total of 7377 patients.Among these,3728 and 3649 cases were in the DAA and PA groups,respectively.There was no difference between the DAA and PA groups at postoperative week 2 in the number of patients using the assistive ambulatory device as well as in time to completely discontinue all assistive ambulatory devices(OR=1.01,95%CI:0.11~9.27,P=0.99;MD=-6.97,95%CI:-14.36~0.42,PP=0.06).Hospitalization stay in the DAA group was shorter than in the PA group(MD=-0.45,95%CI:-0.80~-0.10 P=0.01),whose patients had shorter operative time(MD=12.88,95%CI:1.15~24.60,P=0.03).Radiographic outcomes showed that DAA group have more cups in Lewinnek safe zoom(OR=1.70,95%CI : 1.17~2.48,P=0.006),but there was little difference in Leg-Length Discrepancy betweenthe DAA and PA groups(MD=-0.19,95%CI :-0.62~0.24,P=0.39).In addition,the dislocation rate of the two groups postoperative was little difference(OR=0.78,95%CI:0.47~1.28,P=0.32).The proportions of intraoperative fractures and postoperative lateral cutaneous nerve of thigh(LCNT)neuropraxia were significantly higher in the DAA group than in patients that underwent PA(OR=81.26,95%CI : 15.43~427.98,P < 0.00001;OR=2.30,95%CI :1.12~4.73 P=0.02).Descriptive analysis found that DAA was slightly better than PA regarding early functional recovery and activity ability after surgery,and postoperative pain relief.Conclusion:Although the Leg-Length Discrepancy and dislocation rate postoperative did not reflect any differences,furthermore,DAA is more incline to intraoperative fractures and postoperative complications such as LCNT neuropraxia.But compared with PA,DAA has advantage in Early functional rehabilitation,pain relief and prosthesis position after THA.