Direct anterior vs other surgical approaches in patients with lumbar stiffness undergoing total hip arthroplasty: a systematic review and meta-analysis

Introduction: The effectiveness of the direct anterior approach (DAA) compared to other surgical approaches for total hip arthroplasty (THA) in patients with lumbar spine stiffness remains unclear. This systematic review and meta-analysis aimed to compare clinical outcomes, including dislocation rates and other complications, between DAA and other surgical approaches for THA in patients with lumbar spine stiffness.

Materials and methods: We conducted a systematic review and meta-analysis to compare the DAA with other surgical approaches (anterolateral, direct lateral, posterolateral and direct superior) in patients with lumbar spine stiffness undergoing THA. We searched PubMed, Embase, and Cochrane Central databases for cohort studies and randomized controlled trials and calculated risk ratios (RRs) with 95% confidence intervals (CIs) to assess dislocation rates.

Results: This analysis included 11 non-randomized studies comprising 2505 patients, of whom 738 patients (29.4%) underwent THA via DAA. The results demonstrated that the DAA group had significantly reduced dislocation rates (RR 0.31, 95% CI 0.14-0.67, P = 0.003, I² = 0%) compared to other surgical approaches. Subgroup analysis showed significantly lower dislocation rates in DAA patients versus those undergoing the posterior approach (RR 0.22, 95% CI 0.10-0.52, P = 0.001, I² = 0%). However, there was no statistically significant difference in dislocation rates between DAA and the lateral approach (RR 0.53, 95% CI 0.19-1.47, P = 0.22, I² = 0%), although the rate was numerically lower.

Conclusion: The DAA was associated with lower dislocation rates compared to other surgical techniques in patients with lumbar spine stiffness undergoing THA.