Systematic review on the curative effect of total hip arthroplasty through direct anterior approach versus posterolateral Approach

Objective To systematic evaluate the curative effect of total hip arthroplasty (THA) through direct anterior approach versus (DAA) posterolateral approach (PSA). Methods All the randomized controlled trial (RCT) articles and observational research articles about the curative effect of THA through direct anterior approach (DAA group) versus posterolateral approach (PSA group)for treatment of hip disease that published at home and abroad included from database establishing to December 2017 were retrieved from Cochrane Library, Pubmed, Web of Science, CBM and China national knowledge internet (CNKI) through computer. The articles were screened and the information was extracted independently by two authors. A Meta-analysis was performed utilizing the RevMan 5.3 software. Results Two hundred and forty-nine articles were searched out in the initial stage. After screening, 7 Chinese articles and 2 English articles (942 cases)were included in the final analysis, including 8 RCT articles and 1 observational research article, and 463 patients in direct anterior approach and 479 patients in posterolateral approach. The results of Meta-analysis demonstrated that the incision length, operation time, intraoperative blood less, Harris hip function scores at 1 month after surgery, visual analogue scale (VAS) scores at 24 hours after surgery, postoperative bed rest time and the hospital stay were better in DAA group compared to PSA group (SMD=-2.51, 95% CI: -4.84, -0.19, P=0.03); (SMD=0.84, 95% CI: 0.10, 1.59, P=0.03); (SMD=-1.52, 95% CI: -2.98, -0.05, P=0.04); (SMD=2.58, 95% CI: 0.65, 4.51, P=0.009); (SMD=-0.65, 95% CI: -0.91, -0.38, P<0.01); (SMD=-1.85, 95% CI: -3.00, -0.70, P=0.002); (SMD=-1.12, 95% CI: -1.62, -0.61, P<0.01). There were no statistical difference in drainage (SMD=-1.45, 95% CI: -3.40, 0.49, P=0.14), Harris hip function scores at last follow-up (SMD=0.91, 95% CI: -0.31, 2.14, P=0.15), VAS scores at 48 hours after surgery (SMD=-1.21, 95% CI: -3.03, 0.61, P=0.19), acetabular anteversion angles (SMD=-0.50, 95% CI: -1.06, 0.05, P=0.07), acetabular abduction angles (SMD=-0.01, 95% CI: -0.32, 0.30, P=0.97) and incidence of complications (OR=1.10, 95% CI: 0.59, 2.07, P=0.77) between the 2 groups. The result of analysis of publication bias according to Harris hip function scores at last follow-up and incidence of complications showed that the funnel-plot was essentially bilateral symmetry. Conclusions THA through DAA can significantly reduce the soft-tissue damage, and it is beneficial for patient's quick recovery, also it conforms to the current concept of minimally invasive treatment that worthy of promotion. Key words: Arthroplasty, replacement, hip; Meta-analysis