Wound complications and clinical efficacy of the direct anterior approach versus the posterolateral approach in total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials.

Authors

Wangjie Fu, Yong Deng, Jiongnan Xu, Keyi Chen, Luolong Wang, Songyu He, Jun Zhang

Published in

BMC surgery. Jul 04, 2026. Epub Jul 04, 2026.

Abstract

The direct anterior approach (DAA) and the posterolateral approach (PLA) are commonly used surgical techniques in total hip arthroplasty (THA). However, whether DAA is associated with different wound complication rates compared with PLA remains controversial. This meta-analysis aimed to compare wound complications and clinical outcomes between DAA and PLA in THA based on randomized controlled trials.
A comprehensive search was conducted across six major electronic databases: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and Chongqing VIP Information (CQVIP). The search strategy encompassed studies indexed from database inception to 31 December 2025. The primary outcomes were wound complications, including incisional infection, hematoma, and delayed wound healing. Predefined eligibility criteria were applied during study screening. The risk of bias of the included studies was assessed using the revised Cochrane Risk of Bias tool for randomized trials (RoB 2). The PLA group was used as the control group. Data were extracted from the included randomized controlled trials (RCTs). A pooled statistical analysis was performed to estimate the rate of wound complications and to compare the clinical effects of DAA and PLA. The meta-analysis was conducted with Review Manager 5.3 and Stata 15.
A total of 18 eligible RCTs, comprising 1,485 patients, were included. Compared with PLA, DAA was associated with decreased rates of incisional infection (RR = 0.48, P = 0.03, I² = 0%) and a lower overall rate of wound complications (RR = 0.58, P = 0.04, I² = 0%). No evidence of a significant difference between groups was observed for hematoma incidence, poor wound healing, or overall surgical complications. Regarding perioperative indicators, DAA demonstrated several advantages. DAA was associated with a shorter incision length (MD = -3.44, P < 0.001, I² = 97%), less intraoperative blood loss (MD = -76.74, P < 0.001, I² = 97%), and a shorter hospital stay (MD = -2.15, P < 0.001, I² = 95%). In terms of functional recovery, DAA demonstrated better early postoperative function. The DAA group had higher HHS at 1 month (MD = 5.87, P < 0.001, I² = 15%), 3 months (MD = 5.10, P < 0.001, I² = 95%), and 6 months (MD = 2.94, P < 0.001, I² = 92%). No significant difference was observed at 12 months. For pain outcomes, DAA was associated with lower VAS scores in the postoperative period, including at 1 day (MD = -0.84, P < 0.001, I² = 59%), 3 days (MD = -0.77, P < 0.001, I² = 76%), 7 days (MD = -0.85, P < 0.001, I² = 88%), 1 month (MD = -0.49, P = 0.002, I² = 90%), 3 month (MD = -0.67, P = 0.02, I² = 96%), and 6 month (MD = -0.12, P = 0.04, I² = 75%).
Compared with the PLA, the DAA is associated with improved perioperative outcomes following THA. Specifically, the DAA demonstrates a lower incidence of incision infection, fewer overall wound complications, shorter incision length, reduced intraoperative blood loss, and a shorter length of hospital stay. Early postoperative functional outcomes and pain, assessed by HHS and VAS, are also superior with the DAA. However, owing to heterogeneity and limited robustness of certain outcomes, these findings should be interpreted with caution. Further high-quality randomized controlled trials are warranted to confirm these results.

PMID:
42401861
Bibliographic data and abstract were imported from PubMed on 05 Jul 2026.

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