Functional Outcomes of Primary Total Hip Arthroplasty between Direct Anterior Approach and Posterior Approach: A Systematic Review and Meta-Analysis

Abstract

Introduction: Less-invasive approach to hip joint replacement promotes postoperative recovery and can reduce soft tissue damage and blood loss that promotes the recovery of normal daily functions. However, the incidence of complications in DAA is relatively high at the early technical learning level.

Methods: A systematic review was conducted in accordance to PRISMA guidelines through PubMed, Google Scholar, and Cochrane Library. After that, the study assessed with assessment of study quality and risk of bias assessed using criteria developed by the Oxford Center for Evidence-based Medicine.

Results: From 208 records, remaining 5 studies were included. There was a significant difference in incision length between PLA and DAA. (Mean Difference = 3.43, 95% CI 3.31 to 3.54, P <0.01). Furthermore, there was a significant difference in length of hospital stay (LOS) between PLA and DAA (Mean Difference = 0.47, 95% CI 0.37 to 0.57, P <0.01). There was also a significant difference between the two groups in terms of the 3 months post-operative HHS score (MD = -1.34, 95% CI − 2.15 to 0.52, p < 0.01) with significant difference heterogeneity (I2 = 79%).

Discussion: Few studies stated that there was no significance difference for the comparison of the length of the incision between the DAA and PLA in primary THA. Also, a statistically significant difference in length of hospital stay between DAA and PLA were found. Meanwhile, several studies found that there was no significant difference between the DAA group and PA group in terms of the length of hospital stay.

Conclusion: HLA was preferable effective compared to DAA in Haris Hip Score functional outcome. However further researches with more sample size were still needed.