In-hospital outcomes with anterior versus posterior approaches in total hip arthroplasty: meta-analysis of randomized controlled trials

Abstract

Larry E Miller,1 Atul F Kamath,2 Friedrich Boettner,3 Samir K Bhattacharyya4 1Miller Scientific Consulting, Inc., Asheville, NC, USA; 2Penn Medicine, Department of Orthopedic Surgery, Leonard Davis Institute of Health Economics, Philadelphia, PA, USA; 3Hospital for Special Surgery, New York, NY, USA; 4DePuy Synthes, Raynham, MA, USA Purpose: The purpose of this study was to determine whether in-hospital outcomes are different with anterior approach (AA) or posterior approach (PA) in primary total hip arthroplasty (THA). Methods: We performed a systematic review with random-effects meta-analysis of randomized controlled trials (RCTs) comparing AA with PA in primary THA. Hospital outcomes were reported as odds ratio (OR), weight mean difference, or standardized mean difference (SMD). Results: A total of seven RCTs with 609 patients were included. Outcomes favoring AA included 1.4 cm shorter incision (p=0.045), 0.5 days shorter hospital stay (p=0.01), 0.5 points less pain on a 0–10 scale (p=0.007), and less opioid use (SMD=-0.39 corresponding to 12 fewer morphine equivalents per day, p=0.01). The procedure time was 16 minutes longer with AA vs. PA (p=0.002). There were no statistical differences between AA and PA in operative blood loss (mean difference =19 mL, p=0.71), transfusions (9.7% vs. 16.2%, OR=0.45, p=0.39), or complications (5.5% vs. 4.1%, OR=1.42, p=0.62). Conclusion: While the AA to primary THA may take longer time compared with the PA, the incision is shorter, and patients report slightly less pain, require less opioid medication, and leave the hospital earlier. The clinical relevance of these differences during longer-term follow-up is uncertain. The choice of surgical approach in primary THA should also consider factors such as experience of the surgeon and preferences of the surgeon and patient. Keywords: complications, opioid, pain, systematic review, THA

Keywords

• anterior approach
• lateral approach
• posterior approach
• systematic review
• THA