The direct anterior approach in total hip arthroplasty: a systematic review of the literature
2017
Aims The most effective surgical approach for total hip arthroplasty
(THA) remains controversial. The direct anterior approach may be
associated with a reduced risk of dislocation, faster recovery,
reduced pain and fewer surgical complications. This systematic review
aims to evaluate the current evidence for the use of this approach
in THA. Materials and Methods Following the Cochrane collaboration, an extensive literature
search of PubMed, Medline, Embase and OvidSP was conducted. Randomised
controlled trials, comparative studies, and cohort studies were
included. Outcomes included the length of the incision, blood loss,
operating time, length of stay, complications, and gait analysis. Results A total of 42 studies met the inclusion criteria. Most were of
medium to low quality. There was no difference between the direct
anterior, anterolateral or posterior approaches with regards to
length of stay and gait analysis. Papers comparing the length of the incision found similar lengths
compared with the lateral approach, and conflicting results when
comparing the direct anterior and posterior approaches. Most studies found the mean operating time to be significantly
longer when the direct anterior approach was used, with a steep
learning curve reported by many. Many authors used validated scores including the Harris hip score,
and the Western Ontario and McMaster Universities Arthritis Index.
These mean scores were better following the use of the direct anterior
approach for the first six weeks post-operatively. Subsequently
there was no difference between these scores and those for the posterior
approach. Conclusion There is little evidence for improved kinematics or better long-term
outcomes following the use of the direct anterior approach for THA.
There is a steep learning curve with similar rates of complications,
length of stay and outcomes. Well-designed, multi-centre, prospective randomised controlled
trials are required to provide evidence as to whether the direct
anterior approach is better than the lateral or posterior approaches
when undertaking THA. Cite this article: Bone JointJ 2017;99-B:732–40.
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