A meta-analysis comparing the direct anterior with other approaches in primary total hip arthroplasty

Background: Proponents of the direct anterior approach (DAA) for THAs suggest earlier recovery with no increased complications whereas opponents suggest higher complication rates. Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) to compare the outcomes of the DAA versus other surgical approaches in primary THAs. Results: We identified 18 RCTs suitable for detailed extraction of the data. The RCTs included a total of 1661 patients with a mean age of 62 years (range 55-69). Using the DAA led to a significant improvement in the Harris Hip score by a mean of 5.6 points (95% confidence interval (CI) 4.3 to 6.8, p < 0.01, heterogeneity I-2 18%) and the WOMAC score by a mean of -3.1. points (95% CI -4.1 to -2.1, p < 0.001, I-2 0%) at 6 weeks postoperatively, reduction in the analgesic requirements on the day of surgery (Morphine Equivalents -3.6 95% CI -6.5 to -0.7, p = 0.02, I-2 50%) and pain scores on day one postoperatively (VAS -1.3 95% CI -1.5 to -1.1, p < 0.01, I-2 91%). DAA was associated with a smaller incision (-3.2 cm 95% CI -3.3 to -3.1, p < 0.01, I-2 99%) and there was no significant difference in complication rates (P = 0.20) among the study groups. Conclusion: Based on the available studies, the DAA offers superior functional outcomes over other approaches in the immediate postoperative period after primary THA with no increased risk of complications. However, there was no evidence to support the superiority of any approach beyond 6 weeks postoperatively. (C) 2018 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.