Direct superior approach versus posterior approach in patients with primary total hip arthroplasty: a systematic
Mariany H Miyamoto1, Marcos N Goularte1, Ruan Pablo S Gomes2
1Universidade da Região de Joinville, UNIVILLE, Joinville, SC, Brazil.
Objectives:
The benefits and risks of the minimally invasive direct superior approach (DSA) compared with the posterior approach (PA) in primary total hip arthroplasty (THA) remain uncertain.
Methods:
We performed a systematic review and meta-analysis comparing DSA and PA in primary THA. Outcomes included perioperative parameters, radiological and functional results, and postoperative complications. Statistical analysis was performed using Review Manager, with heterogeneity assessed using I2. Subgroup analyses were restricted to randomised controlled trials (RCTs).
Results:
11 studies comprising 5217 patients were included, with 1259 undergoing DSA. DSA was associated with a shorter hospital stay (MD -0.67 days; p < 0.00001), reduced blood loss (MD -66.09 mL; p = 0.007), and increased Harris Hip Scores (HHS) within 3 months (MD 1.00; p = 0.03). No significant differences were observed in operating time, radiological outcomes, Oxford Hip Score, Western Ontario and McMaster Universities Osteoarthritis Score, 12-month HHS, or postoperative complications. Subgroup analysis revealed differences between RCTs and observational studies in length of stay (p < 0.0004), leg-length discrepancy (p = 0.07), and operating time (p = 0.04).
Conclusions:
DSA appears to be a safe, effective alternative to PA, providing less blood loss, shorter hospitalisation, and faster early recovery without compromising mid-term outcomes.
