Direct anterior vs. posterior approach in hip arthroplasty: A systematic review and meta-analysis for Asian demographics.

Background: The Direct Anterior Approach (DAA) in Total Hip Arthroplasty (THA) is gaining popularity due to faster recovery and lower dislocation rates than the Posterior Approach (PA). However, its adoption in Asia remains limited. This systematic review compares functional, radiological, and clinical outcomes of DAA and PA in Asian populations. Methods: A systematic search was conducted in PubMed, Embase, Cochrane Library, Google Scholar, and regional databases (up to September 2024). Comparative studies (RCTs, cohort studies) on DAA vs. PA in Asian adults were included. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool for RCTs and the Newcastle-Ottawa Scale for cohort studies. Meta-analysis was performed using RevMan 5.3, applying fixed or random-effects models based on heterogeneity (I Results: Eight studies (1 RCT, 7 cohort studies) with 886 patients (DAA: 451, PA: 435) were included. Most studies were from China (4), Japan (2), India (1), and Singapore (1). Meta-analysis showed shorter hospital stays with DAA (MD: -2.38 days, 95 % CI: -3.69 to -1.07, p = 0.0004), with no significant differences in operative time and blood loss. Radiological outcomes were similar. DAA had better early functional outcomes (1-3 months) but showed no long-term differences. DAA was associated with a higher risk of nerve injury. Conclusion: DAA and PA yield comparable functional and clinical outcomes in the Asian population. Although concerns about the learning curve have limited DAA adoption, structured training can mitigate these challenges. Given its increasing global acceptance, DAA is a viable alternative for THA in Asia. Prospero registration number: CRD42024598643.