Direct anterior approach versus posterolateral approach in total hip arthroplasty: a Meta-analysis

Objective To compare the efficacy and safety of direct anterior approach (DAA)with posterolateral approach(PLA)in the treatment of total hip arthroplasty. Methods Reports using case-control studies and randomized clinical trials to compare the DAA with PLA in the treatment of total hip arthroplasty were retried from China National Knowledge Internet, Wanfang Data, PubMed Library, and Cochrane Library, from January 2010 to April 2018. The searched key words were "direct anterior approach" "posterolateral approach" "total hip arthroplasty" . Methodological quality of the trials was critically assessed. Statistical software Revman 5.3 was used for data analysis, and average operation time, average length of hospital stay, VAS, HHS score, average blood loss, fracture post operation, infection, and dislocation of hip joint were analyzed. Results A total of 6 341 patients from 14 articles were included, 3 282 patients using DAA and 3 059 patients using PLA. Three randomized controlled trials were low risk evaluated by Cochrane Collaboration risk of bias assessment tool, and ten cases controlled trials were high quality and one case controlled trial was middle quality evaluated by the Newcastle-Ottawa scale risk of bias assessment tool. The results showed that, when the efficacy, safety of DAA approach and PLA approach were compared in the treatment of total hip arthroplasty, there was statistical significance in the average operation time(WMD=17.26, 95%CI 7.22-27.30, P 0.05); infection(OR=0.77, 95%CI 0.21-2.79, P>0.05); dislocation of hip joint (OR=0.68, 95%CI 0.40-1.18, P>0.05). Conclusions Both approaches achieve similar and satisfactory clinical effect in the total hip arthroplasty in the period of follow-up time. The DAA is superior to the PLA in the total hip arthroplasty in regards to the average hospital stay, VAS, HHS. PLA has a shorter operation time and less blood loss. Key words: Arthroplasty, replacement, hip; Direct anterolateral approach; Posterolateral Approach; Meta analysis