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The direct anterior approach in total hip arthroplasty: a systematic review of the literature

2024; Volume: 75; Issue: 4 Linguagem: Inglês

10.23736/s2784-8469.24.04415-8

2784-871X

M Khalil, Monketh Jaibaji, Rawan Jaibaji, Yousif MAHMOUD, Andrea Volpin,

Orthopedic Infections and Treatments

INTRODUCTION: The optimal surgical approach for total hip arthroplasty (THA) remains a subject of debate. The direct anterior approach sparked interest due to the unique internervous and muscle sparing nature of the dissection. This has been theorized to have several advantages over more widely used approaches. The aim is to comprehensively assess the current landscape of evidence supporting the efficacy and clinical benefits of employing the direct anterior approach.EVIDENCE ACQUISITION: A systematic review in accordance with PRISMA guidance was conducted accords multiple databases; EMBASE, MEDLINE OvidSP, Web of Science, Cochrane Central, PubMed, Publisher and Google Scholar. The inclusion criteria encompassed randomized controlled trials, comparative investigations, and cohort studies comparing the direct anterior approach to an alternative surgical approach to total hip arthroplasty. Evaluation parameters comprised measures relating to surgical incision length, intra-operative blood loss quantification, operative time, duration of hospital stay, incidence of complications, and postoperative gait analysis where present.EVIDENCE SYNTHESIS: 46 studies met the inclusion criteria. The majority of these studies were rated as being moderate to low quality. Notably, no substantial variances were observed among the direct anterior, anterolateral, or posterior approaches concerning both the duration of hospital stay and gait analysis outcomes. Comparisons of incision length revealed similar measurements when juxtaposed with the lateral approach. Conversely, when contrasting the direct anterior and posterior approaches, conflicting outcomes regarding incision length were reported across studies. There was significantly increased operative time associated with the utilization of the direct anterior approach, a phenomenon often linked to a steep learning curve highlighted in multiple studies. Initial 6-week PROMS were superior for the direct anterior approach however there was no long-term difference in PROMS between the various approaches.CONCLUSIONS: The current evidence suggests a lack of substantial support for enhanced kinematics or superior long-term outcomes resulting from the application of the direct anterior approach in total hip arthroplasty (THA). While early clinical outcomes may be superior with the direct anterior approach. This method exhibits a significant learning curve, yielding comparable rates of complications, hospital stays, and overall long outcomes.