Direct superior approach versus posterior approach in patients with primary total hip arthroplasty: a systematic review and meta-analysis

Objectives: The benefits and risks of the minimally invasive direct superior approach (DSA) compared with the posterior approach (PA) in primary total hip arthroplasty (THA) remain uncertain. Methods: We performed a systematic review and meta-analysis comparing DSA and PA in primary THA. Outcomes included perioperative parameters, radiological and functional results, and postoperative complications. Statistical analysis was performed using Review Manager, with heterogeneity assessed using I 2 . Subgroup analyses were restricted to randomised controlled trials (RCTs). Results: 11 studies comprising 5217 patients were included, with 1259 undergoing DSA. DSA was associated with a shorter hospital stay (MD −0.67 days; p < 0.00001), reduced blood loss (MD −66.09 mL; p = 0.007), and increased Harris Hip Scores (HHS) within 3 months (MD 1.00; p = 0.03). No significant differences were observed in operating time, radiological outcomes, Oxford Hip Score, Western Ontario and McMaster Universities Osteoarthritis Score, 12-month HHS, or postoperative complications. Subgroup analysis revealed differences between RCTs and observational studies in length of stay ( p < 0.0004), leg-length discrepancy ( p = 0.07), and operating time ( p = 0.04). Conclusions: DSA appears to be a safe, effective alternative to PA, providing less blood loss, shorter hospitalisation, and faster early recovery without compromising mid-term outcomes.