REVIEW article
Front. Surg.
Sec. Orthopedic Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1586187
This article is part of the Research TopicNew Advances in Prosthetic Surgery of Large JointsView all 8 articles
Comparison of Direct Anterior vs. Posterior Approach in Primary Total Hip Arthroplasty: A Systematic Review and Meta-Analysis on Enhanced Recovery After Surgery
Provisionally accepted
Wenqian Xu1Jinjin Lao2Jinsong Liu1Zengrui Zhang1Xiaoyu Wan1Zhiguang Chen1Xiaotao Huang2Nan Chen1
Yingxing Xu1*- 1The First Affiliated Hospital of Kunming Medical University, Kunming, China
- 2Cixi Integrated Traditional Chinese and Western Medicine Medical and Health Group, Cixi, China
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Purpose: This meta-analysis aimed to compare the direct anterior approach (DAA) and posterior approach (PA) for total hip arthroplasty (THA) within the context of enhanced recovery after surgery (ERAS).Methods: Studies comparing DAA and PA for THA were systematically retrieved from Pubmed, Embase, Web of Science, the Cochrane Library, and Google Scholar databases, covering the period from 2012 to 2024. A meta-analysis was conducted to compare the ERAS-related outcomes between DAA and PA for THA using RevMan 5.3 software, including surgical trauma, muscle damage, functional recovery, and complications. Heterogeneity was considered significant if I² > 50%, in which case a random effects model and subgroup analysis were applied. Continuous and dichotomous data were analyzed using 95% confidence intervals (CIs).Methodological quality and heterogeneity assessments were also conducted.Results: A total of 48 studies, including 46,367 hips (13,285 in the DAA group and 33,082 in the PA group), were included. Compared to PA, DAA was associated with significantly lower blood transfusion rates [6.62% vs 14.52%; odds ratio (OR) = 0.73; 95% CI: 0.59 -0.91; P < 0.005], shorter hospital stay [mean difference (MD) = -0.88 days; 95%
Keywords: Direct anterior approach, Posterior approach, Total hip arthroplasty, Enhanced recovery after surgery, meta analysis
Received: 02 Mar 2025; Accepted: 23 Jul 2025.
Copyright: © 2025 Xu, Lao, Liu, Zhang, Wan, Chen, Huang, Chen and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yingxing Xu, The First Affiliated Hospital of Kunming Medical University, Kunming, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.