Direct Anterior Approach In Total Hip Arthroplasty: A Systematic Review Of Clinical Evidence On Postoperative Recovery
Year: 2026
Type: review
Study design: Systematic Review
Abstract: Background: The direct anterior approach (DAA) for total hip arthroplasty (THA) has been proposed as a muscle-sparing surgical route that may accelerate postoperative recovery.Nevertheless, the magnitude, consistency, and durability of this advantage remain debated.Objective: To synthesize open-access, English-language clinical studies evaluating DAA in THA and its relationship with postoperative recovery.Methodology: PubMed/MEDLINE, ScienceDirect/Open Access, MEDLINE-indexed open repositories, and LILACS/SciELO were searched.Eligible studies were randomized clinical trials, prospective comparative studies, retrospective comparative cohorts, propensity-score matched cohorts, and clinical cohort studies with patient-level postoperative outcomes.Reviews, meta-analyses, editorials, technique-only articles, non-English studies, closed-access articles, case reports, and revision-only THA studies were excluded.A total of 327 records were identified; 232 records were screened after duplicate removal; 71 full-text clinical articles were assessed for eligibility; and 22 clinical studies were included in the qualitative synthesis.Quality assessment: Randomized trials were appraised using domains consistent with the Cochrane RoB 2 framework.Nonrandomized clinical studies were assessed using principles consistent with ROBINS-I, emphasizing confounding, selection bias, outcome measurement, missing data, and selective reporting.Results: The clinical evidence included suggests that DAA may improve early postoperative recovery, particularly early pain, early mobilization, physical activity, gait-aid discontinuation, length of stay, and short-term patient-reported function.However, functional differences commonly diminish by 3 to 12 months.Complications and recovery outcomes are strongly influenced by surgeon experience, patient selection, wound risk, femoral exposure, perioperative protocols, and rehabilitation pathways.Conclusion: DAA may accelerate early postoperative recovery after THA in selected patients and experienced centers.However, current clinical evidence does not demonstrate consistent medium-or long-term functional superiority over other well-performed approaches.The overall certainty of evidence is moderate for early recovery and low-to-moderate for sustained functional superiority.
Source: The journal of orthopaedics.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7167012002