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POSTERIOR VERSUS ANTERIOR APPROACH TO TOTAL HIP ARTHROPLASTY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED
Lorenzo Fagotti1,2, Guilherme Guadagnini Falotico1, Daniel Augusto Maranho2,3
1Universidade Federal de São Paulo, Department of Orthopedics and Traumatology, Sports Traumatology Center (CETE), São Paulo, SP, Brazil.
Insights
The posterior approach for total hip arthroplasty (THA) offers shorter surgery times, while the anterior approach may reduce hospital stays and improve early functional recovery. Both approaches have distinct benefits for primary THA patients.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Total hip arthroplasty (THA) is a common procedure for hip joint replacement.
- Choosing between posterior and anterior surgical approaches is a key decision in THA.
- Understanding the comparative outcomes of these approaches is crucial for patient care.
Purpose of the Study:
- To systematically review and meta-analyze clinical and surgical outcomes of posterior versus anterior approaches in primary total hip arthroplasty (THA).
Main Methods:
- Systematic review and meta-analysis adhering to Cochrane Handbook and PRISMA guidelines.
- Inclusion of randomized controlled trials (RCTs) comparing posterior and anterior THA approaches.
- Searched PubMed, Cochrane, and Virtual Health Library databases for studies with quantifiable functional outcomes.
Main Results:
- Analysis of 10 RCTs involving 774 patients.
- Posterior approach: associated with significantly shorter operative time (15.98 minutes shorter).
- Anterior approach: associated with shorter hospital stay (0.31 days shorter) and greater early functional improvement (4.06 points higher Harris Hip Score up to 6 months).
Conclusions:
- The posterior approach for primary THA is linked to reduced operative time.
- The anterior approach demonstrates potential for decreased hospital length of stay and enhanced short-term functional restoration.
- Both approaches offer specific advantages that may influence surgical decision-making in primary THA.
Objective:
To perform a systematic review and meta-analysis to compare clinical and surgical outcomes of posterior versus 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 randomized 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.
