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      The direct anterior approach in total hip arthroplasty : a systematic review of the literature

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          Abstract

          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.

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          Most cited references47

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          Anterior vs. posterior approach for total hip arthroplasty, a systematic review and meta-analysis.

          The objective of this study is to compare the clinical, radiographic and surgical outcomes among patients undergoing primary THA performed via the anterior versus posterior approach. We searched numerous sources and eventually included 17 studies, totaling 2302 participants. In terms of post-operative pain and function, the anterior approach was significantly favored in 4 studies at short-term follow-up. Pooled estimates showed a significant difference in favor of the anterior approach in terms of length of stay and dislocations. Current evidence comparing outcomes following anterior versus posterior THA does not demonstrate clear superiority of either approach. Until more rigorous, randomized evidence is available, we recommend choice of surgical approach for THA be based on patient characteristics, surgeon experience and surgeon and patient preference. Copyright © 2014 Elsevier Inc. All rights reserved.
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            Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty.

            Benefits of a direct anterior approach (DAA) versus a posterior-lateral (PA) approach to THA were assessed in a single-surgeon, IRB-approved, prospective, randomized clinical study. Subjects (43 DAA and 44 PA) were evaluated at 6 weeks, and 3, 6 and 12 months. The primary end point was ability to climb stairs normally and walk unlimited at each time point. Secondary end points included assessment by several outcome instruments. DAA subjects performed better during the immediate post-operative period; they had lower VAS pain scores on the first post-operative day, more subjects climbing stairs normally and walking unlimited at 6 weeks, and higher HOOS Symptoms scores at 3 months. There were no significant differences between groups at later time points. Findings confirm previous reports of benefits of DAA versus PA in early post-operative phases. Copyright © 2013 Elsevier Inc. All rights reserved.
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              Prospective randomized study of two surgical approaches for total hip arthroplasty.

              The benefits of different surgical approaches for total hip arthroplasty continue to be debated. One hundred patients were prospectively enrolled and randomized into 2 groups. One group underwent total hip arthroplasty through a single-incision modified Smith-Peterson approach, whereas the other group underwent total hip arthroplasty through a direct lateral approach. All patients received the same postoperative protocol. Evaluation included operative time, estimated blood loss, analgesia requirement, transfusions, and length of stay. Functional outcome was assessed preoperatively and postoperatively. 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. At 2 years, the results in both groups were the same.
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                Author and article information

                Journal
                The Bone & Joint Journal
                The Bone & Joint Journal
                British Editorial Society of Bone & Joint Surgery
                2049-4394
                2049-4408
                June 2017
                June 2017
                : 99-B
                : 6
                : 732-740
                Affiliations
                [1 ]Bravis Hospital, Boerhaaveplein 1, 4624VT Bergen op Zoom, The Netherlands.
                [2 ]University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK.
                [3 ]NIHR University College London Hospitals Biomedical Research Centre, UK.
                Article
                10.1302/0301-620X.99B6.38053
                28566391
                9d6f4dc2-8f17-4949-bf39-0f430281810d
                © 2017
                History

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