A comparison of clinical,radiographic and surgical outcomes of total hip arthroplasty between direct anterior and posterior approaches: a systematic review and meta-analysis
Restricted accessResearch articleFirst published online November, 2019
A comparison of clinical,radiographic and surgical outcomes of total hip arthroplasty between direct anterior and posterior approaches: a systematic review and meta-analysis
A systematic review and meta-analysis were used to directly evaluate the direct anterior approach (DAA) and the posterior approach (PA) for early efficacy and safety of total hip arthroplasty (THA).
Methods:
Control-led trials assessing DAA and PA for the efficacy and safety of THA were searched in the database. Articles were reviewed according to predetermined inclusion and exclusion criteria; the quality of the methodology 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 or in time needed to completely discontinue all assistive ambulatory devices.
Descriptive analysis found that DAA was slightly better than PA regarding early functional recovery and activity after surgery, as well as postoperative pain relief. Hospitalisation stay in the DAA group was shorter than in the PA group, in which the patients had a shorter operative time. Radiographic outcomes showed that there was little difference in prosthetic position between the DAA and PA groups. The proportions of intraoperative fractures and postoperative lateral cutaneous nerve of the thigh (LCNT) neuropraxia were significantly higher in the DAA group than in patients who underwent PA.
Conclusion:
Compared with PA, DAA presents superior early recovery following THA.
KurtzSMLauEOngK, et al. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res2009; 467: 2606–2612.
2.
EthgenOBruyèreORichyF, et al. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am2004; 86: 963–974.
3.
BergerRAJacobsJJMeneghiniRM, et al. Rapid rehabilitation and recovery with minimally invasive total hip arthroplasty. Clin Orthop Relat Res2004; 429: 239–247.
4.
RestrepoCParviziJPourAE, et al. Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty2010; 25: 671–679.e1.
5.
MattaJMShahrdarCFergusonT.Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res2005; 441: 115–124.
6.
PostZDOrozcoFDiaz-LedezmaC, et al. Direct anterior approach for total hip arthroplasty: indications, technique, and results. J Am Acad Orthop Surg2014; 22: 595–603.
7.
OinumaKEingartnerCSaitoY, et al. Total hip arthroplasty by a minimally invasive, direct anterior approach. Oper Orthop Traumatol2007; 19: 310–326.
8.
BalBSVallurupalliS.Minimally invasive total hip arthroplasty with the anterior approach. Indian J Orthop2008; 42: 301–308.
9.
KennonREKeggiJMWetmoreRS, et al. Total hip arthroplasty through a minimally invasive anterior surgical approach. J Bone Joint Surg Am2003; 85(Suppl 4): 39–48.
10.
SiguierTSiguierMBrumptB.Mini-incision anterior approach does not increase dislocation rate: a study of 1037 total hip replacements. Clin Orthop Relat Res2004; 426: 164–173.
11.
MichelMCWitschgerP.MicroHip: a minimally invasive procedure for total hip replacement surgery A modified Smith-Petersen approach. Hip Int2006; 16(Suppl 3): 40–47.
12.
WaddellJJohnsonKHeinW, et al. Orthopaedic practice in total hip arthroplasty and total knee arthroplasty: results from the Global Orthopaedic Registry (GLORY). Am J Orthop (Belle Mead NJ)2010; 39(Suppl): 5–13.
13.
RobertsJMFuFHMcClainEJ, et al. A comparison of the posterolateral and anterolateral approaches to total hip arthroplasty. Clin Orthop Relat Res1984; 187: 205–210.
14.
PaillardP.Hip replacement by a minimal anterior approach. Int Orthop2007; 31 (Suppl 1): S13–S15.
15.
ParratteSPagnanoMW.Muscle damage during minimally invasive total hip arthroplasty: cadaver-based evidence that it is significant. Instr Course Lect2008; 57: 231–234.
16.
MeneghiniRMPagnanoMWTrousdaleRT, et al. Muscle damage during MIS total hip arthroplasty: Smith-Petersen versus posterior approach. Clin Orthop Relat Res2006; 453: 293–298.
17.
BerendKRLombardiAVJrSengBE, et al. Enhanced early outcomes with the anterior supine intermuscular approach in primary total hip arthroplasty. J Bone Joint Surg Am2009; 91(Suppl 6): 107–120.
18.
MoskalJTCappsSGScanelliJA.Anterior muscle sparing approach for total hip arthroplasty. World J Orthop2013; 4: 12–18.
19.
GoebelSSteinertAFSchillingerJ, et al. Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach. Int Orthop2012; 36: 491–498.
20.
SarialiELeonardPMamoudyP.Dislocation after total hip arthroplasty using Hueter anterior approach. J Arthroplasty2008; 23: 266–272.
21.
PfirrmannCWNotzliHPDoraC, et al. Abductor tendons and muscles assessed at MR imaging after total hip arthroplasty in asymptomatic and symptomatic patients. Radiology2005; 235: 969–676.
22.
ChimentoGFPavoneVSharrockN, et al. Minimally invasive total hip arthroplasty: a prospective randomized study. J Arthroplasty2005; 20: 139–144.
23.
JiWStewartN.Fluoroscopy assessment during anterior minimally invasive hip replacement is more accurate than with the posterior approach. Int Orthop2016; 40: 21–27.
24.
HamiltonWGParksNLHuynhC.Comparison of cup alignment, jump distance, and complications in consecutive series of anterior approach and posterior approach total hip arthroplasty. J Arthroplasty2015; 30: 1959–1962.
25.
NamDSculcoPKSuEP, et al. Acetabular component positioning in primary THA via an anterior, posterolateral, or posterolateral-navigated surgical technique. Orthopedics2013; 36: e1482–e1487.
26.
NamDSculcoPKAbdelMP, et al. Leg-length inequalities following THA based on surgical technique. Orthopedics2013; 36: e395–e400.
27.
PilotPKerensBDraijerWF, et al. Is minimally invasive surgery less invasive in total hip replacement? A pilot study. Injury2006; 37(Suppl 5): S17–S23.
28.
RoparsMMorandiXHutenD, et al. Anatomical study of the lateral femoral cutaneous nerve with special reference to minimally invasive anterior approach for total hip replacement. Surg Radiol Anat2009; 31: 199–204.
29.
HarrisWH.Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am1969; 51: 737–755.
30.
BellamyNBuchananWWGoldsmithCH, et al. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol1988; 15: 1833–1840.
31.
DawsonJFitzpatrickRMurrayD, et al. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br1998; 80: 63–69.
32.
BijurPESilverWGallagherEJ.Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med2001; 8: 1153–1157.
33.
LewinnekGELewisJLTarrR, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am1978; 60: 217–220.
34.
HigginsJPAltmanDGGøtzschePC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ2011; 343: d5928.
ChengTEWallisJATaylorNF, et al. A prospective randomized clinical trial in total hip arthroplasty-comparing early results between the direct anterior approach and the posterior approach. J Arthroplasty2017; 32: 883–890.
37.
MalekIARoyceGBhattiSU, et al. A comparison between the direct anterior and posterior approaches for total hip arthroplasty: the role of an ‘Enhanced Recovery’ pathway. Bone Joint J2016; 98-B: 754–760.
38.
MartinCTPugelyAJGaoY, et al. A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. J Arthroplasty2013; 28: 849–854.
39.
TripuraneniKRMunsonNRArchibeckMJ, et al. Acetabular abduction and dislocations in direct anterior vs posterior total hip arthroplasty: a retrospective, matched cohort study. J Arthroplasty2016; 31: 2299–2302.
40.
ChristensenCPJacobsCA.Comparison of patient function during the first six weeks after direct anterior or posterior total hip arthroplasty (THA): a randomized study. J Arthroplasty2015; 30(Suppl): 94–97.
41.
BerginPFDoppeltJDKephartCJ, et al. Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage markers. J Bone Joint Surg Am2011; 93: 1392–1398.
42.
TauntonMJMasonJBOdumSM, et al. Direct anterior total hip arthroplasty yields more rapid voluntary cessation of all walking aids: a prospective, randomized clinical trial. J Arthroplasty2014; 29(Suppl): 169–172.
43.
Poehling-MonaghanKLKamathAFTauntonMJ, et al. Direct anterior versus miniposterior THA with the same advanced perioperative protocols: surprising early clinical results. Clin Orthop Relat Res2015; 473: 623–631.
44.
RathodPABhallaSDeshmukhAJ, et al. Does fluoroscopy with anterior hip arthroplasty decrease acetabular cup variability compared with a nonguided posterior approach?Clin Orthop Relat Res2014; 472: 1877–1885.
45.
SchweppeMLSeylerTMPlateJF, et al. Does surgical approach in total hip arthroplasty affect rehabilitation, discharge disposition, and readmission rate. Surg Technol Int2013; 23: 219–227.
46.
RodriguezJADeshmukhAJRathodPA, et al. Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach. Clin Orthop Relat Res2014; 472: 455–463.
47.
ZawadskyMWPaulusMCMurrayPJ, et al. Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases. J Arthroplasty2014; 29: 1256–1260.
48.
BalasubramaniamUDowseyMMaF, et al. Functional and clinical outcomes following anterior hip replacement: a 5-year comparative study versus posterior approach. ANZ J Surg2016; 86: 589–593.
49.
SpaansAJvan den HoutJABolderSB.High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach. Acta Orthop2012; 83: 342–346.
50.
El BitarYFStoneJCJacksonTJ, et al. Leg-length discrepancy after total hip arthroplasty: comparison of robot-assisted posterior, fluoroscopy-guided anterior, and conventional posterior approaches. Am J Orthop (Belle Mead NJ)2015; 44: 265–269.
51.
MarattJDGagnierJJButlerPD, et al. No difference in dislocation seen in anterior vs posterior approach total hip arthroplasty. J Arthroplasty2016; 31(Suppl): 127–130.
52.
BarrettWPTurnerSELeopoldJP.Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty2013; 28: 1634–1638.
53.
HigginsBTBarlowDRHeagertyNEAnteriorvs, et al. posterior approach for total hip arthroplasty, a systematic review and meta-analysis. J Arthroplasty2015; 30: 419–434.
54.
BremerAKKalbererFPfirrmannCW, et al. Soft-tissue changes in hip abductor muscles and tendons after total hip replacement: comparison between the direct anterior and the transgluteal approaches. J Bone Joint Surg Br2011; 93: 886–889.
55.
KimSLosinaESolomonDH, et al. Effectiveness of clinical pathways for total knee and total hip arthroplasty: literature review. J Arthroplasty2003; 18: 69–74.
56.
ShethDCafriGInacioMC, et al. Anterior and anterolateral approaches for THA are associated with lower dislocation risk without higher revision risk. Clin Orthop Relat Res2015; 473: 3401–3408.
57.
GouldingKBeauléPEKimPR, et al. Incidence of lateral femoral cutaneous nerve neuropraxia after anterior approach hip arthroplasty. Clin Orthop Relat Res2010; 468: 2397–2404.
58.
RathodPAOrishimoKFKremenicIJ, et al. Similar improvement in gait parameters following direct anterior & posterior approach total hip arthroplasty. J Arthroplasty2014; 29: 1261–1264.
59.
WintherSBHusbyVSFossOA, et al. Muscular strength after total hip arthroplasty. A prospective comparison of 3 surgical approaches. Acta Orthop2016; 87: 22–28.
60.
WangCGLiYMZhangHF, et al. Anterior approach versus posterior approach for Pipkin I and II femoral head fractures: A systemic review and meta-analysis. Int J Surg2016; 27: 176–181.
61.
WoolsonSTPouliotMAHuddlestonJI.Primary total hip arthroplasty using an anterior approach and a fracture table: short-term results from a community hospital. J Arthroplasty2009; 24: 999–1005.
62.
PogliacomiFParaskevopoulosACostantinoC, et al. Influence of surgical experience in the learning curve of a new approach in hip replacement: anterior mini-invasive vs. standard lateral. Hip Int2012; 22: 555–561.
