Comparison of the clinical outcome after total hip endoprosthesis via the direct anterior or lateral approach: a systematic review with metaanalysis
DOI:
https://doi.org/10.6016/ZdravVestn.3179Keywords:
total hip arthroplasty, lateral approach, direct anterior approach, clinical outcome, metaanalysisAbstract
Background: The total hip endoprosthesis is one of the most successful elective surgical procedures in orthopaedic surgery. The choice of a surgical approach importantly influences the outcome of the intervention and globally, there is a preference towards the lateral approach. However, the direct anterior approach is gaining popularity, primarily due to less soft tissue trauma than in the lateral approach.
Methods: Our meta-analysis only included randomised control trials, which were selected from three English databases: PubMed, Cochrane Library, and Clinical Trials. The search was performed in December 2019. Information on country, sample size, intervention, outcome, and follow-up period has been extracted. The meta-analysis was performed using Review Manager 5.3.
Results: Seven randomized controlled trials totalling 723 patients were included. Comparing direct anterior and lateral approach to the total hip arthroplasty, no difference was found in the functional status graded using the Harris hip score at the end of follow-up, pain reported with visual analogue scale in the early and late postoperative period, blood loss, need for transfusion, length of hospital stay and appearance of the intra- and postoperative complications.
Conclusions: Comparison of the direct anterior and the lateral approach shows that there is no significant difference between the two approaches in functional status, pain reported in the early and late postoperative period, blood loss, need for transfusion, length of hospital stays, and occurrence of the intra- and postoperative complications. To date, there is no randomized controlled trial directly comparing clinical outcomes between the two approaches with a well-determined protocol.
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