The direct anterior approach in total hip arthroplasty: A SYSTEMATIC REVIEW OF THE LITERATURE

@article{Meermans2017TheDA,
  title={The direct anterior approach in total hip arthroplasty: A SYSTEMATIC REVIEW OF THE LITERATURE},
  author={Geert Meermans and Sujith Konan and Rishi Das and Andrea Volpin and Fares Sami Haddad},
  journal={The Bone \& Joint Journal},
  year={2017},
  volume={99B},
  pages={732–740}
}
Aims The most effective surgical approach for total hip arthroplasty (THA) remains controversial. The direct anterior approach may be associated with a reduced risk of dislocation, faster recovery, reduced pain and fewer surgical complications. This systematic review aims to evaluate the current evidence for the use of this approach in THA. Materials and Methods Following the Cochrane collaboration, an extensive literature search of PubMed, Medline, Embase and OvidSP was conducted. Randomised… 
Direct anterior versus lateral approaches for clinical outcomes after total hip arthroplasty: a meta-analysis
TLDR
Current evidence demonstrated a trend showing that the DAA had a better effect on pain relief and blood-saving effects for THA patients, however, considering the number and sample size of the included trials, more large-scale RCTs with high quality are needed to confirm the conclusion.
Comparisons between Direct Anterior Approach and Lateral Approach for Primary Total Hip Arthroplasty in Postoperative Orthopaedic Complications: A Systematic Review and Meta‐Analysis
TLDR
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TLDR
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TLDR
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TLDR
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TLDR
The direct anterior approach for THA appears to be a safe and effective option, however, there is no significant difference in hospital length of stay or postoperative recovery between the 2 approaches.
Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review
TLDR
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Does Surgical Approach Affect Outcomes in Total Hip Arthroplasty Through 90 Days of Follow-Up? A Systematic Review With Meta-Analysis.
TLDR
Patients treated with AA reported less pain, consumed fewer narcotics, and reported better hip function, and the choice of surgical approach in primary THA should consider preference and experience of the surgeon as well as preference and anatomy of the patient.
POSTERIOR VERSUS ANTERIOR APPROACH TO TOTAL HIP ARTHROPLASTY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
TLDR
Whereas the posterior approach to primary THA is associated with a shorter operative time, the anterior approach has the potential to decrease the length of stay and provide greater short-term functional restoration.
Modern cup alignment techniques in total hip arthroplasty: A systematic review.
TLDR
Alternative methods accounting for the functional acetabular orientation seem to be clinically safe and effective in the early-term, and generate acceptable cup orientation on radiographs.
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TLDR
Meta-analysis showed that DAA was associated with significantly shorter hospitalization than the lateral approach, as well as greater functional rehabilitation and lower perceived pain during the early postoperative period, and the available evidence is still insufficient to conclude whether the DAA or lateral approach is superior for total hip arthroplasty.
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TLDR
Until more rigorous, randomized evidence is available, it is recommended choice of surgical approach for THA be based on patient characteristics, surgeon experience and surgeon and patient preference.
Surgical Approach, Abductor Function, and Total Hip Arthroplasty Dislocation
TLDR
Larger controlled prospective studies are needed to investigate the potential benefits of the posterior approach in lieu of a dislocation rate six times higher than the direct lateral approach for primary total hip arthroplasty.
Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings
TLDR
Patients treated with a minimally invasive direct anterior approach to total hip replacement surgery had a better perioperative outcome than patients treated with the lateral approach, and the longer time of surgery for the minimallyvasive direct posterior approach may be attributed to the learning curve.
Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases.
TLDR
In the anterior groups, there was significantly less use of assistive devices and narcotics at 6 weeks, and pain was significantly lower, and recovery in a matched cohort of patients.
High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach
TLDR
The direct anterior approach for total hip arthroplasty gives a higher complication rate than the posterolateral approach, however the high complication rate in their study seems to be due to the effect of the learning curve and the use of a minimal invasive approach, instead of theUse of thedirect anterior approach.
Primary total hip arthroplasty: a comparison of the lateral Hardinge approach to an anterior mini-invasive approach
TLDR
The changeover to the anterior mini-invasive approach resulted in a drastic increase in the number of overall complications accompanied by less soft tissue damage and a shorter period of rehabilitation.
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TLDR
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Direct Anterior versus Miniposterior THA With the Same Advanced Perioperative Protocols: Surprising Early Clinical Results
TLDR
There was no systematic advantage of direct anterior THA versus miniposterior THA and factors other than surgical approach, perhaps including attentive pain management, patient selection, surgical volume and experience, careful preoperative templating, and rapid rehabilitation protocols, may be more important in terms of influencing early recovery after THA.
Prospective randomized study of two surgical approaches for total hip arthroplasty.
TLDR
Up to 1-year follow-up, the direct anterior group demonstrated significantly better improvement in both the mental and physical health dimensions of Short Form-36 and Western Ontario McMaster Osteoarthritis Index compared with direct lateral approach group.
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