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Clinical, functional and radiographic outcomes of primary total hip arthroplasty between direct anterior approach and posterior approach: a systematic review and meta-analysis.

Abstract：

BACKGROUND:The purpose of this systematic review and meta-analysis was to compare the direct anterior approach and posterior approach for primary total hip arthroplasty in terms of the clinical, functional and radiographic outcomes. METHODS:We searched the PubMed and EMBASE databases and Cochrane Library from their inception to November 1, 2019. We searched for previously published articles and meta-analyses of randomized controlled trials. RESULTS:A total of 7 randomized controlled trials with 600 participants met the inclusion criteria. Among these patients, 301 and 299 were included in the DAA and PA groups, respectively. The DAA was associated with a longer surgery by a mean duration of 13.74 min (95% CI 6.88 to 20.61, p < 0.0001, I2 = 93%). The postoperative early functional outcomes were significantly better in the DAA group than in the PA group, such as the Visual Analogue Scale (VAS) score at 1 day postoperatively (MD = -0.65, 95% CI - 0.91 to - 0.38, p < 0.00001, I2 = 0%), VAS score at 2 days postoperatively (MD = -0.67, 95% CI - 1.34 to - 0.01, p = 0.05, I2 = 88%) and Harris Hip Score (HHS) at 6 weeks postoperatively (MD = 6.05, 95% CI 1.14 to 10.95, p = 0.02, I2 = 52%). There was no significant difference between the DAA and PA groups in the length of the incision, hospital length of stay (LOS), blood loss, transfusion rates or complication rates. We found no significant difference between the two groups regarding late functional outcomes, such as the VAS score at 12 months postoperatively or the HHS scores at 3, 6, and 12 months postoperatively. A significant difference in the radiographic outcomes was not detected. CONCLUSIONS:The DAA requires a longer surgery time than does the PA in primary total hip arthroplasty. The DAA yields better early functional recovery than does the PA. There was no significant difference between the two groups in terms of other clinical, complication-related, late functional or radiographic outcomes. The evidence on the superiority of the DAA is insufficient and needs to be studied further.

journal_name

BMC Musculoskelet Disord

journal_title

BMC musculoskeletal disorders

authors

Peng L,Zeng Y,Wu Y,Zeng J,Liu Y,Shen B

doi

10.1186/s12891-020-03318-x

subject

Has Abstract

pub_date

2020-06-02 00:00:00

pages

338

issue

issn

1471-2474

pii

10.1186/s12891-020-03318-x

journal_volume

pub_type

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Clinical, functional and radiographic outcomes of primary total hip arthroplasty between direct anterior approach and posterior approach: a systematic review and meta-analysis.