Posterior approach versus lateral approach for primary total hip arthroplasty: An updated systematic review and meta-analysis

Abstract

Total hip arthroplasty (THA) has become one of the most therapeutic and cost-effective procedures that are frequently carried out in orthopedic surgery. This review aimed to systematically compare postoperative outcomes between the two most commonly performed surgical approaches for THA posterior approach (PA) and lateral approach (LA) for abductor strength, operative time, perioperative blood loss, and limb length discrepancy. We searched Medline, Ovid, Europe PMC, Web of Science, and CENTRAL to identify eligible studies comparing PA and LA for patients who underwent primary THA for any indication. No restrictions on date or language were applied. Out of 15,764 records identified, 16 studies were deemed eligible, including five randomized controlled trials, five prospective cohort studies, and six retrospective cohort studies, providing data for 16,964 patients. PA was associated with a significant recovery in abductor strength (standardized mean difference (SMD) = 0.39, 95% confidence interval [CI] 0.14–0.63) postoperatively. No significant difference between PA and LA was found in terms of operative time (SMD = 0.05, 95% CI − 0.40–0.50), perioperative blood loss (SMD = −0.29, 95% CI − 0.62–0.03), or mean radiographic limb length discrepancy (LLD) (SMD = 0.02, 95% CI − 0.21–0.25). After removing the heterogeneity source, the sensitivity analysis showed consistent results except for operative time, which was significantly lower in the PA group (SMD= −0.72, 95% CI − 0.81–0.62). This review found PA to be associated with a significant enhancement in abductor strength recovery following THA. No significant difference was found between the two surgical approaches in operative time, perioperative blood loss, and LLD. However, after removing the source of heterogeneity, the sensitivity analysis showed a significantly lower mean operative time in favor of the PA group. Further studies are warranted to delineate the surgical approach s influence on abductor strength recovery in the long term.