Comparing posterior, anterior, and direct superior approaches in total hip arthroplasty: a network meta-analysis

Autores de IIS La Fe

• Gonzalo Mariscal Ruiz-Rico

  Autor

Participantes ajenos a IIS La Fe

• Soler F.
• Hernandez J.
• Lamo-Espinosa J.M.
• Khalil I.

Grupos

• Cirugía Ortopédica y Traumatología

Abstract

Purpose: To compare functional outcomes and complications between posterior approach (PA), direct anterior approach (DAA), and direct superior approach (DSA) in hip surgery. Methods: PRISMA guidelines and PICOS framework were followed. Databases searched included PubMed, Embase, Scopus, and Cochrane Library. Analysis was performed using Review Manager 5.4 to calculate odds ratios, mean differences, and standard mean differences with 95% CIs. Results: Analysis included 13 studies (972 patients). PA demonstrated significantly shorter surgery time (MD -11.92; 95% CI, -18.48–-5.36). No significant differences were found in dislocation (OR 0.98; 95% CI, 0.31–3.07), periprosthetic fracture (OR 1.21; 95% CI 0.36–4.03), deep vein thrombosis (OR 3.06; 95% CI, 0.47–19.76), infection (OR 0.62; 95% CI, 0.16–2.39), or reoperation rates (OR 0.67; 95% CI 0.20–2.28). Hip function at 2–4 weeks favoured DSA over DAA (MD -4.39; 95% CI, -5.60–-3.19), but showed no significant differences at 12 months (SMD -0.10; 95% CI -0.31–0.12). Pain showed no significant differences at either 2–4 weeks (MD 0.10; 95% CI -0.96–1.16) or 12 months (MD 0.07; 95% CI, -0.05–0.18). Conclusions: PA showed shorter surgery time, and DSA demonstrated better short-term functional results. No significant differences in complications, pain, or long-term functional results were found between approaches. PROSPERO registration CRD42024592000. © The Author(s) 2026

Keywords

• Anterior approach; complications; direct superior approach; hip arthroplasty; posterior approach; PROM