Efficacy of total hip arthroplasty by direct anterior and direct lateral approach: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

YAN Lei ¹ , LIU Huachen ² , SHI Jiayu ² , XING Dan ³ , LI Chuan ⁴ ,  LV Zhi ¹ ,  WANG Bin ¹

1. Department of Orthopaedics, Second Hospital of Shanxi Medical University, Taiyuan 030001, P.R.China;
2. Shanxi Medical University, Taiyuan 030001, P.R.China;
3. Arthritis Clinic & Research Center, Peking University People’s Hospital, Beijing 010000, P.R.China;
4. Department of Orthopaedic, 920^th Hospital of Joint Logistics Support Force, Kunming 650032, P.R.China;

Corresponding author：

LV Zhi, Email: zhilv2009@yahoo.com.cn; WANG Bin, Email: wangbin_pku@163.com

Keywords：

Direct anterior approach; Direct lateral approach; Total hip arthroplasty; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.202107031

Video：

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Objective To systematically review the efficacy of total hip arthroplasty by direct anterior approach (DAA) and direct lateral approach (DLA). Methods CNKI, WanFang Data, VIP, CBM, EMbase, PubMed, The Cochrane Library, ClinicalTrials.gov and PROSPERO databases or websites were electronically searched to collect randomized controlled trials (RCTs) of DAA and DLA for THA from inception to August 6^th, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 9 RCTs were included. The results of meta-analysis showed that at 3 months post-operation, the Harris hip score (HHS) of the DAA group was higher than the DLA group (MD=4.83, 95%CI 2.09 to 7.56, P=0.000 5). Besides, compared with the DLA group, the DAA group showed shorter incision length (MD=−2.35, 95%CI −3.90 to −0.79, P=0.003), less intraoperative bleeding (MD=−68.24, 95%CI −119.07 to −17.41, P=0.009), and shorter hospital stay (MD=−0.84, 95%CI −1.54 to −0.15, P=0.02). However, no significant differences were found between DLA and DAA in operation duration and HHS at 6 weeks after operation. Conclusions Current evidence shows that DAA can provide better HHS at 3 months post-operation, shorter incision length, less intraoperative bleeding, and shorter hospitalization length than DLA. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.

Citation： YAN Lei, LIU Huachen, SHI Jiayu, XING Dan, LI Chuan, LV Zhi, WANG Bin. Efficacy of total hip arthroplasty by direct anterior and direct lateral approach: a systematic review. Chinese Journal of Evidence-Based Medicine, 2021, 21(10): 1162-1167. doi: 10.7507/1672-2531.202107031 Copy

1.	De Anta-Díaz B, Serralta-Gomis J, Lizaur-Utrilla A, et al. No differences between direct anterior and lateral approach for primary total hip arthroplasty related to muscle damage or functional outcome. Int Orthop, 2016, 40(10): 2025-2030.
2.	Dienstknecht T, Lüring C, Tingart M, et al. A minimally invasive approach for total hip arthroplasty does not diminish early post-operative outcome in obese patients: a prospective, randomised trial. Int Orthop, 2013, 37(6): 1013-1018.
3.	Dienstknecht T, Lüring C, Tingart M, et al. Total hip arthroplasty through the mini-incision (Micro-hip) approach versus the standard transgluteal (Bauer) approach: a prospective, randomised study. J Orthop Surg (Hong Kong), 2014, 22(2): 168-172.
4.	Mjaaland KE, Kivle K, Svenningsen S, et al. Do postoperative results differ in a randomized trial between a direct anterior and a direct lateral approach in THA. Clin Orthop Relat Res, 2019, 477(1): 145-155.
5.	Reichert JC, von Rottkay E, Roth F, et al. A prospective randomized comparison of the minimally invasive direct anterior and the transgluteal approach for primary total hip arthroplasty. BMC Musculoskelet Disord, 2018, 19(1): 241.
6.	Imamura M, Munro NA, Zhu S, et al. Single mini-incision total hip replacement for the management of arthritic disease of the hip: a systematic review and meta-analysis of randomized controlled trials. J Bone Joint Surg Am, 2012, 94(20): 1897-1905.
7.	McGrory B, Callaghan J, Kraay M, et al. Editorial: minimally invasive and small-incision joint replacement surgery: what surgeons should consider. Clin Orthop Relat Res, 2005, 440: 251-254.
8.	Højer Karlsen AP, Geisler A, Petersen PL, et al. Postoperative pain treatment after total hip arthroplasty: a systematic review. Pain, 2015, 156(1): 8-30.
9.	Marques EM, Jones HE, Elvers KT, et al. Local anaesthetic infiltration for peri-operative pain control in total hip and knee replacement: systematic review and meta-analyses of short- and long-term effectiveness. BMC Musculoskelet Disord, 2014, 15: 220.
10.	Kurtz S, Mowat F, Ong K, et al. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am, 2005, 87(7): 1487-1497.
11.	Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am, 2007, 89(4): 780-785.
12.	边焱焱, 程开源, 常晓, 等. 2011至2019年中国人工髋膝关节置换手术量的初步统计与分析. 中华骨科杂志, 2020, 40(21): 1453-1460.
13.	Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty, 2013, 28(9): 1634-1638.
14.	van der Sijp MPL, Schipper IB, Keizer SB, et al. Prospective comparison of the anterior and lateral approach in hemiarthroplasty for hip fractures: a study protocol. BMC Musculoskelet Disord, 2017, 18(1): 361.
15.	白波, 陈玉书. 中国微创全髋人工关节置换术的现状和将来. 中华关节外科杂志(电子版), 2015, 9(6): 707-710.
16.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (version 5.1. 0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
17.	Brismar BH, Hallert O, Tedhamre A, et al. Early gain in pain reduction and hip function, but more complications following the direct anterior minimally invasive approach for total hip arthroplasty: a randomized trial of 100 patients with 5 years of follow up. Acta Orthop, 2018, 89(5): 484-489.
18.	Restrepo C, Parvizi J, Pour AE, et al. Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty, 2010, 25(5): 671-679.
19.	孙明辉, 王渭君, 闵令田, 等. 直接前方入路与直接外侧入路人工全髋关节置换术的临床效果比较研究. 现代生物医学进展, 2020, 20(15): 2952-2956.
20.	唐雪彬, 岳喜军, 黄凯, 等. 侧卧位直接前方入路与直接外侧入路在初次全髋关节置换术中的应用. 医学理论与实践, 2020, 33(10): 1579-1581.
21.	智春升, 邬波, 金冶华, 等. 侧卧位直接前方入路与直接外侧入路初次全髋关节置换术的早期疗效比较. 中华骨与关节外科杂志, 2019, 12(1): 18-22.
22.	Garratt A, Schmidt L, Mackintosh A, et al. Quality of life measurement: bibliographic study of patient assessed health outcome measures. BMJ, 2002, 324(7351): 1417.
23.	Kunkel ST, Sabatino MJ, Kang R, et al. A systematic review and meta-analysis of the direct anterior approach for hemiarthroplasty for femoral neck fracture. Eur J Orthop Surg Traumatol, 2018, 28(2): 217-232.
24.	Dimitriou D, Helmy N, Hasler J, et al. The role of total hip arthroplasty through the direct anterior approach in femoral neck fracture and factors affecting the outcome. J Arthroplasty, 2019, 34(1): 82-87.
25.	Lamontagne M, Varin D, Beaulé PE. Does the anterior approach for total hip arthroplasty better restore stair climbing gait mechanics. J Orthop Res, 2011, 29(9): 1412-1417.
26.	Mayr E, Nogler M, Benedetti MG, et al. A prospective randomized assessment of earlier functional recovery in THA patients treated by minimally invasive direct anterior approach: a gait analysis study. Clin Biomech (Bristol, Avon), 2009, 24(10): 812-818.
27.	Nakata K, Nishikawa M, Yamamoto K, et al. A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty, 2009, 24(5): 698-704.
28.	Wamper KE, Sierevelt IN, Poolman RW, et al. The Harris hip score: Do ceiling effects limit its usefulness in orthopedics. Acta Orthop, 2010, 81(6): 703-707.
29.	Müller M, Tohtz S, Springer I, et al. Randomized controlled trial of abductor muscle damage in relation to the surgical approach for primary total hip replacement: minimally invasive anterolateral versus modified direct lateral approach. Arch Orthop Trauma Surg, 2011, 131(2): 179-189.
30.	Nakamura S, Matsuda K, Arai N, et al. Mini-incision posterior approach for total hip arthroplasty. Int Orthop, 2004, 28(4): 214-217.
31.	Wright JM, Crockett HC, Delgado S, et al. Mini-incision for total hip arthroplasty: a prospective, controlled investigation with 5-year follow-up evaluation. J Arthroplasty, 2004, 19(5): 538-545.
32.	Moskal JT, Capps SG. Is limited incision better than standard total hip arthroplasty? A meta-analysis. Clin Orthop Relat Res, 2013, 471(4): 1283-1294.
33.	Xu CP, Li X, Song JQ, et al. Mini-incision versus standard incision total hip arthroplasty regarding surgical outcomes: a systematic review and meta-analysis of randomized controlled trials. PLoS One, 2013, 8(11): e80021.
34.	McGrory BJ, Finch ME, Furlong PJ, et al. Incision length correlates with patient weight, height, and gender when using a minimal-incision technique in total hip arthroplasty. J Surg Orthop Adv, 2008, 17(2): 77-81.
35.	Yue C, Kang P, Pei F. Comparison of direct anterior and lateral approaches in total hip arthroplasty: a systematic review and meta-analysis (PRISMA). Medicine (Baltimore), 2015, 94(50): e2126.
36.	Wang Z, Bao HW, Hou JZ. Direct anterior versus lateral approaches for clinical outcomes after total hip arthroplasty: a meta-analysis. J Orthop Surg Res, 2019, 14(1): 63.

1. De Anta-Díaz B, Serralta-Gomis J, Lizaur-Utrilla A, et al. No differences between direct anterior and lateral approach for primary total hip arthroplasty related to muscle damage or functional outcome. Int Orthop, 2016, 40(10): 2025-2030.
2. Dienstknecht T, Lüring C, Tingart M, et al. A minimally invasive approach for total hip arthroplasty does not diminish early post-operative outcome in obese patients: a prospective, randomised trial. Int Orthop, 2013, 37(6): 1013-1018.
3. Dienstknecht T, Lüring C, Tingart M, et al. Total hip arthroplasty through the mini-incision (Micro-hip) approach versus the standard transgluteal (Bauer) approach: a prospective, randomised study. J Orthop Surg (Hong Kong), 2014, 22(2): 168-172.
4. Mjaaland KE, Kivle K, Svenningsen S, et al. Do postoperative results differ in a randomized trial between a direct anterior and a direct lateral approach in THA. Clin Orthop Relat Res, 2019, 477(1): 145-155.
5. Reichert JC, von Rottkay E, Roth F, et al. A prospective randomized comparison of the minimally invasive direct anterior and the transgluteal approach for primary total hip arthroplasty. BMC Musculoskelet Disord, 2018, 19(1): 241.
6. Imamura M, Munro NA, Zhu S, et al. Single mini-incision total hip replacement for the management of arthritic disease of the hip: a systematic review and meta-analysis of randomized controlled trials. J Bone Joint Surg Am, 2012, 94(20): 1897-1905.
7. McGrory B, Callaghan J, Kraay M, et al. Editorial: minimally invasive and small-incision joint replacement surgery: what surgeons should consider. Clin Orthop Relat Res, 2005, 440: 251-254.
8. Højer Karlsen AP, Geisler A, Petersen PL, et al. Postoperative pain treatment after total hip arthroplasty: a systematic review. Pain, 2015, 156(1): 8-30.
9. Marques EM, Jones HE, Elvers KT, et al. Local anaesthetic infiltration for peri-operative pain control in total hip and knee replacement: systematic review and meta-analyses of short- and long-term effectiveness. BMC Musculoskelet Disord, 2014, 15: 220.
10. Kurtz S, Mowat F, Ong K, et al. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am, 2005, 87(7): 1487-1497.
11. Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am, 2007, 89(4): 780-785.
12. 边焱焱, 程开源, 常晓, 等. 2011至2019年中国人工髋膝关节置换手术量的初步统计与分析. 中华骨科杂志, 2020, 40(21): 1453-1460.
13. Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty, 2013, 28(9): 1634-1638.
14. van der Sijp MPL, Schipper IB, Keizer SB, et al. Prospective comparison of the anterior and lateral approach in hemiarthroplasty for hip fractures: a study protocol. BMC Musculoskelet Disord, 2017, 18(1): 361.
15. 白波, 陈玉书. 中国微创全髋人工关节置换术的现状和将来. 中华关节外科杂志(电子版), 2015, 9(6): 707-710.
16. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (version 5.1. 0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
17. Brismar BH, Hallert O, Tedhamre A, et al. Early gain in pain reduction and hip function, but more complications following the direct anterior minimally invasive approach for total hip arthroplasty: a randomized trial of 100 patients with 5 years of follow up. Acta Orthop, 2018, 89(5): 484-489.
18. Restrepo C, Parvizi J, Pour AE, et al. Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty, 2010, 25(5): 671-679.
19. 孙明辉, 王渭君, 闵令田, 等. 直接前方入路与直接外侧入路人工全髋关节置换术的临床效果比较研究. 现代生物医学进展, 2020, 20(15): 2952-2956.
20. 唐雪彬, 岳喜军, 黄凯, 等. 侧卧位直接前方入路与直接外侧入路在初次全髋关节置换术中的应用. 医学理论与实践, 2020, 33(10): 1579-1581.
21. 智春升, 邬波, 金冶华, 等. 侧卧位直接前方入路与直接外侧入路初次全髋关节置换术的早期疗效比较. 中华骨与关节外科杂志, 2019, 12(1): 18-22.
22. Garratt A, Schmidt L, Mackintosh A, et al. Quality of life measurement: bibliographic study of patient assessed health outcome measures. BMJ, 2002, 324(7351): 1417.
23. Kunkel ST, Sabatino MJ, Kang R, et al. A systematic review and meta-analysis of the direct anterior approach for hemiarthroplasty for femoral neck fracture. Eur J Orthop Surg Traumatol, 2018, 28(2): 217-232.
24. Dimitriou D, Helmy N, Hasler J, et al. The role of total hip arthroplasty through the direct anterior approach in femoral neck fracture and factors affecting the outcome. J Arthroplasty, 2019, 34(1): 82-87.
25. Lamontagne M, Varin D, Beaulé PE. Does the anterior approach for total hip arthroplasty better restore stair climbing gait mechanics. J Orthop Res, 2011, 29(9): 1412-1417.
26. Mayr E, Nogler M, Benedetti MG, et al. A prospective randomized assessment of earlier functional recovery in THA patients treated by minimally invasive direct anterior approach: a gait analysis study. Clin Biomech (Bristol, Avon), 2009, 24(10): 812-818.
27. Nakata K, Nishikawa M, Yamamoto K, et al. A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty, 2009, 24(5): 698-704.
28. Wamper KE, Sierevelt IN, Poolman RW, et al. The Harris hip score: Do ceiling effects limit its usefulness in orthopedics. Acta Orthop, 2010, 81(6): 703-707.
29. Müller M, Tohtz S, Springer I, et al. Randomized controlled trial of abductor muscle damage in relation to the surgical approach for primary total hip replacement: minimally invasive anterolateral versus modified direct lateral approach. Arch Orthop Trauma Surg, 2011, 131(2): 179-189.
30. Nakamura S, Matsuda K, Arai N, et al. Mini-incision posterior approach for total hip arthroplasty. Int Orthop, 2004, 28(4): 214-217.
31. Wright JM, Crockett HC, Delgado S, et al. Mini-incision for total hip arthroplasty: a prospective, controlled investigation with 5-year follow-up evaluation. J Arthroplasty, 2004, 19(5): 538-545.
32. Moskal JT, Capps SG. Is limited incision better than standard total hip arthroplasty? A meta-analysis. Clin Orthop Relat Res, 2013, 471(4): 1283-1294.
33. Xu CP, Li X, Song JQ, et al. Mini-incision versus standard incision total hip arthroplasty regarding surgical outcomes: a systematic review and meta-analysis of randomized controlled trials. PLoS One, 2013, 8(11): e80021.
34. McGrory BJ, Finch ME, Furlong PJ, et al. Incision length correlates with patient weight, height, and gender when using a minimal-incision technique in total hip arthroplasty. J Surg Orthop Adv, 2008, 17(2): 77-81.
35. Yue C, Kang P, Pei F. Comparison of direct anterior and lateral approaches in total hip arthroplasty: a systematic review and meta-analysis (PRISMA). Medicine (Baltimore), 2015, 94(50): e2126.
36. Wang Z, Bao HW, Hou JZ. Direct anterior versus lateral approaches for clinical outcomes after total hip arthroplasty: a meta-analysis. J Orthop Surg Res, 2019, 14(1): 63.

Chinese Journal of Evidence-Based Medicine

Efficacy of total hip arthroplasty by direct anterior and direct lateral approach: a systematic review

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