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
Abstract
Background: 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.
Methods: 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.
Results: A total of 18 eligible RCTs, comprising 1,485 patients, were included. Compared with PLA, DAA was associated with…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,485 participants or records.
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