• Kunhao Wang, Tao Zhang, Ruiyang Xia, Jiankai Wang, Jinliang Yu, and Wenbo Wang.
• Department of Orthopedics I, Qunli Branch of the First Affiliated Hospital of Harbin Medical University, No. 2075, Qunli 7th Avenue, Daoli District, Harbin City, Heilongjiang Province, 150077, China.
• Arch Orthop Trauma Surg. 2024 Sep 1; 144 (9): 444344534443-4453.

BackgroundTo compare the efficacy of the direct anterior approach (DAA) versus the posterolateral approach (PLA) in total hip arthroplasty (THA) in terms of operation time, incision length, intraoperative blood loss, postoperative pain, and incision infection rate.MethodsWe systematically searched databases including China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Chinese sci-tech journals, Chinese Biomedical Literature Database (CBM), PubMed, and Cochrane Library up to December 2023. We included randomized controlled trials (RCTs) that compared DAA with PLA in THA, with a minimum sample size of 80 and a follow-up of at least 6 months. Studies were screened by two independent researchers, following PRISMA guidelines. Data were extracted using a pre-established feature table, capturing study design, sample size, patient demographics, and outcomes of interest. Meta-analysis was performed using RevMan 5.4.1 software. Heterogeneity was assessed using the Q-value statistical test and I² test. The fixed-effects model was used when heterogeneity was low; otherwise, the random-effects model was applied.ResultsA total of 19 RCTs met the inclusion criteria. The Meta-analysis revealed that DAA was associated with a longer operation time [MD = 5.89, 95%CI(2.26 to 9.51), P = 0.001] but resulted in a smaller incision length [MD = -2.99, 95%CI(-3.76 to -2.22), P < 0.00001], less intraoperative blood loss [MD=-108.36, 95%CI(-131.10 to -85.62), P < 0.00001], lower incidence of postoperative incision infection [OR = 0.39, 95%CI(0.19 to 0.83), P = 0.01], and reduced hip Visual Analog Scale (VAS) scores on the 1st and 3rd days postoperatively [MD=-0.85, 95%CI(-0.96 to -0.74), P < 0.00001; MD=-0.60, 95%CI(-1.13 to -0.07), P = 0.03]. No significant difference was observed in VAS scores on the 7th postoperative day.ConclusionThe DAA for THA offers advantages over PLA, including reduced incision size, blood loss, and postoperative pain, albeit with a longer operation time. These findings should guide clinical decision-making, considering the benefits and potential increased complexity of the DAA.© 2024. The Author(s).

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