Direct Anterior Approach and Posterior Approach for Total Hip Arthroplasty: A Systematic Umbrella Review of Meta-Analyses of Randomized Controlled Trials.

Introduction: Total Hip Arthroplasty (THA) has revolutionized orthopaedic surgery, with demand expected to double by 2030. This umbrella review assessed the efficacy and patient satisfaction of the direct anterior approach (DAA) versus the posterior approach (PA). Methods: We searched three databases. Quality was assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2), and discrepancies were investigated through matrices (PROSPERO: CRD42023450069). Results: Of 11 SRs/MAs comparing DAA to PA, two were low and nine critically low quality. PA reduced operation duration (OD) in five out of eight direct meta-analyses (DMAs) (mean difference [MD] 13.74 to 18.92). PA showed less blood loss (BL) in one DMA (MD 91.87 [27.99, 155.74]), while DAA showed less BL in another (MD -67.02 [-131.46, -2.58]). DAA decreased length of stay (LOS) in three DMAs (MD -0.31 to -0.56). DAA also showed less pain on post-operative days (POD) 1 and 2 in two DMAs (MD -0.65 [-0.91, -0.38] and MD -0.67 [-1.34, -0.01]). No significant differences were observed at post-operative weeks (POW) 2, POW6, or post-operative months (POM) 12. DAA significantly improved hip function at POW2 in one DMA and POW6 in two DMAs and one network meta-analysis (NMA) (MD 3.7 to 6.80), but no significant differences were found at POM6 or POM12.Discrepancies in OD, BL, and LOS results stemmed from study selection factors including non-randomization, language barriers, approach comparisons, search periods, and inconsistencies in reporting. Conclusion: DAA offers advantages in early pain reduction and functional improvement due to its muscle-sparing technique.