Clinical efficacy of direct anterior approach vs. other surgical approaches for total hip arthroplasty: A systematic review and meta-analysis based on RCTs

BACKGROUND: Direct anterior approach (DAA) is an accurate technique for total hip arthroplasty (THA) through the muscle gap. Physicians who apply DAA believe that it accelerates patient recovery and results in lower rates of postoperative dislocation. However, the traditional surgical approach adherents believe that it is shorter and has fewer complications than DAA. METHODS: We use the method of META analysis to organize and analyze the data of the randomized controlled studies (RCT) obtained after our screening. To compare the clinical efficacy of DAA approach and other surgical approaches for THA. RESULTS: After rigorous screening, 15 RCT studies were included in our study, and data were extracted. The study included 1,450 patients from 15 RCTs, with a mean age of 63 years and a distribution of 52–67 years. Six weeks after the operation, the Harris hip score of the DAA approach improved by an average of 4.06 points (95% confidence interval (CI) 2.54 −5.59, P < 0.01, I(2) = 45%, which can significantly improve the clinical efficacy of patients. However, the 0.61 points [95% confidence interval (CI) −1.13 −2.34, P > 0.01, I(2 )= 0%] at 3 months and 1.49 points [95% confidence interval (CI) −1.65 −2.25, P > 0.01, I(2 )= 0%] at 12 months postoperatively. In terms of dislocation rate, results show that the use of DAAs does not reduce Dislocation Rate with significant statistical heterogeneity among study groups (95% CI 0.18–2.94 P > 0.001, I(2 )= 0%). CONCLUSION: The hip function of DAA was superior to posterolateral approach (PLA) and latera approach (LA) in the early days after hip replacement, especially within six weeks. However, at six months or more after surgery, the difference was not significant. The DAA did not show a lower rate of dislocation than other surgical approaches. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO