A Systematic Review and Meta-analysis of Direct Anterior Approach Versus Posterolateral Approach in Total Hip Arthroplasty

Background: To evaluate the difference of clinical results between DAA and PLA in primary THA. Methods: : The PubMed , Embase and the Cochrane Library were searched by computer to collect and compare clinical randomized controlled trials of primary THA through DAA and PLA. The clinical outcome measures include operation time, total blood loss, acetabular abduction angle, acetabular anteversion angle, Harris hip score and postoperative dislocation rate. The Revman 5.3 software provided by the Cochrane Collaborat Network was used for Meta analysis of the data. Results: : A total of 654 patients were included in 8 studies, including 328 patients in DAA group and 326 patients in PLA group. Meta-combined results, The number of acetabular abduction angle in DAA group is smaller than that in PLA group [MD =-0.87, 95%CI(-1.69 ~-0.04), p = 0.04], and the number of acetabular anteversion angle in DAA group is also smaller than that in PLA group [MD =-4.25, 95%CI(-4.96 ~-3.54), p < 0.00001], the differences are statistically significant. 6 weeks after operation, the Harris hip score of DAA was higher than that of PLA [MD = 5.35, 95%CI(2.38 ~ 8.32), P = 0.0004], and the difference was statistically significant. For the total Harris hip score , DAA is higher than PLA, and the difference is statistically significant [MD = 2.3, 95%CI (0.19 ~ 4.41), P = 0.03]; However, other results were not statistically significant. Conclusion: Compared with PLA, DAA can accelerate postoperative rehabilitation of patients, and at the same time can obtain better acetabular prosthesis location.