Related Experiment Video
Updated: Mar 13, 2026
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Clinical and Safety Outcomes after Direct Anterior Total Hip Arthroplasty Compared with Conventional Approaches: A
Supraja Movva1, Satya K Koduru2, Deepthi Roop2
1Department of Obstetrics and Gynaecology, Mid Yorkshire NHS Trust, Wakefield, United Kingdom.
Introduction:
The direct anterior approach (DAA) is promoted as a muscle-sparing technique for primary total hip arthroplasty (THA), but comparative benefits and safety remain debated across settings and study designs.
Materials And Methods:
We performed a Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020-guided systematic review of PubMed, EMBASE, Scopus, Web of Science, MEDLINE, DOAJ, EBSCOhost, and SCIE from inception through 31 December 2023. We included comparative clinical studies of adults undergoing primary THA that directly compared DAA with posterior/posterolateral (and lateral, where available) approaches. Risk of bias was assessed using risk of bias 2 (RoB 2) for randomized trials and a ROBINS-I-aligned framework for observational studies. Random-effects meta-analysis (DerSimonian-Laird) was conducted when ≥2 studies reported comparable outcomes at aligned timepoints.
Discussion:
The search identified 2,548 records; after removing 632 duplicates, 1,916 records were screened and 178 full texts were assessed. Seven studies (1 randomized trial and 6 observational cohorts; 4,685 participants) met the inclusion criteria. For the primary pooled outcome (pain, Visual Analog Scale at 3 months; 2 studies; 437 participants), DAA showed lower pain versus comparator (mean difference [MD] -0.49, 95% confidence interval [CI] -0.66 to -0.32; I2 = 0%). Secondary pooled outcomes suggested a small pain difference at 6 months (MD -0.10, 95% CI -0.18 to -0.02; I2 = 0%) and higher early function at 3 months (Harris hip score MD +7.15, 95% CI 5.28 to 9.02; I2 = 0%). Estimated blood loss favored DAA (MD -81 mL, 95% CI -92.60 to -69.68; I2 = 0%), whereas operative time and length of stay showed substantial heterogeneity and no consistent difference. The randomized trial had some concerns, and observational studies were mainly limited by confounding, yielding an overall moderate-to-serious risk of bias.
Conclusion:
DAA may offer modest early improvements in pain and function after primary THA, with uncertain effects on operative efficiency outcomes that vary by context. Overall certainty of evidence is limited by few poolable studies, mixed designs, and residual confounding; further well-designed pragmatic randomized trials and standardized prospective cohorts are needed.
