POSTERIOR VERSUS ANTERIOR APPROACH TO TOTAL HIP ARTHROPLASTY: A SYSTEMATIC REVIEW AND META- ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Objective: To perform a systematic review and meta-analysis to compare clinical and surgical outcomes of posteriorversus anterior approach to primary total hip arthroplasty (THA). Methods: This study followed the standard methodology established by the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers searched for randomized controlled trials comparing posterior an anterior approach to primary THA with at least one quantifiable functional outcome published in the PubMed , Cochrane , and Virtual Health Library databases. Results: The analysis included ten ran-domized controlled trials conducted with 774 patients. The posterior approach was associated with shorter operative time (mean of 15.98 minutes shorter , 95% CI 11 .21 to 20.76 , p < 0.00001) while the anterior approach was associated with shorter length of hospital stay (0.31 days or about eight hours shorter, 95% CI 0.12 to 0.51, p = 0.002) and greater earlier improvement in functional outcomes up to six months from the procedure (mean Harris Hip Score of 4.06 points greater , 95% CI 2.23 to 5.88, p < 0.0001). Conclusion: Whereas the posterior approach to primary THA is associated with a shorter operative time , the anterior approach has the potential to decrease the length of stay and provide greater short-term functional restoration. Level of evidence I, Systematic Review and Meta-Analysis.