Comparison of functional capacity in the postoperative period of total hip arthroplasty through anterior, lateral and posterior access: a systematic review.
DOI:
https://doi.org/10.37951/2358-9868.2026v14i1.8858Palavras-chave:
Osteoarthritis, Hip, Arthroplasty, Replacement, Hip; Clinical TrialResumo
Introduction: Osteoarthritis (OA) is a common degenerative joint disease in adults and the elderly, characterized by joint stiffness, pain, and disability due to cartilage degeneration. The aging population and rising obesity rates are expected to increase OA's global impact. Treatments include pharmacological, non-pharmacological, alternative therapies, and surgical options like Total Hip Arthroplasty (THA). THA, a procedure to replace the hip joint with a prosthesis, is highly effective and widely performed, especially using the posterior and direct anterior surgical approaches. Material and Methods: This systematic review follows the PRISMA 2020 guidelines and is registered on PROSPERO (CRD42024549538). The aim of his study is to compare the functional outcomes of posterior and direct anterior approaches in THA. It includes randomized clinical trials (RCTs) from 2019-2024 involving patients over 45 undergoing unilateral THA for OA. Data extraction focused on physical capacity, pain, and activity. Quality assessment employed the PEDro bias risk scale. Results and Discussion: Out of 605 articles, three RCTs met the inclusion criteria, involving 185 participants. Studies showed no significant differences in functional outcomes between the approaches, though the direct anterior approach (DAA) had slightly higher scores in some tests. Complications varied, with DAA showing a higher incidence of lateral femoral cutaneous nerve injuries. Despite minor differences, both approaches were effective. Conclusion: Both the posterior and direct anterior approaches to THA are effective, with no significant differences in long-term functional outcomes. However, DAA may lead to more lateral femoral cutaneous nerve injuries. More detailed clinical trials are needed to refine surgical protocols and optimize outcomes for different patient contexts. Limitations: The main limitation is the small number of reviewed articles, highlighting the need for more updated and long-term RCTs comparing these specific surgical approaches.
Referências
Zacharias A, Green RA, Semciw AI, Kingsley MIC, Pizzari T. Efficacy of rehabilitation programs for improving muscle strength in people with hip or knee osteoarthritis: a systematic review with meta-analysis. Osteoarthritis and Cartilage. 2014 Nov;22(11):1752–73.
Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, et al. The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study. Annals of the Rheumatic Diseases. 2014 Feb 19;73(7):1323–30.
Flávio Faloppa, Joao Belloti. Tratamento clínico da osteoartrose: Evidências atuais. ResearchGate [Internet]. 2006 [cited 2024 Oct 4];41(3):47–53. Available from: https://www.researchgate.net/publication/289726801_Tratamento_clinico_da_osteoartrose_Evidencias_atuais
Cosmo TM, Pércio PPV. Comparação das abordagens anterior, lateral e posterior na artroplastia total de quadril: uma revisão bibliográfica. Fag journal of health (FJH) [Internet]. 2020 Dec 20 [cited 2022 Jun 14];2(4):479–82. Available from: https://fjh.fag.edu.br/index.php/fjh/article/view/244/215
Lenza M, Ferraz S de B, Viola DCM, Garcia Filho RJ, Cendoroglo Neto M, Ferretti M. Epidemiology of total hip and knee replacement: a cross-sectional study. Einstein (São Paulo). 2013 Jun;11(2):197–202.
Jones A, Voaklander D, Johnston DWC, Suarez-Almazor ME. Health Related Quality of Life Outcomes After Total Hip and Knee Arthroplasties in a Community Based... The Journal of Rheumatology [Internet]. 2000 Aug [cited 2024 Oct 4];27(7):1745–52. Available from: https://www.researchgate.net/publication/12404758_Health_Related_Quality_of_Life_Outcomes_After_Total_Hip_and_Knee_Arthroplasties_in_a_Community_Based_Population
Petis S, Howard JL, Lanting BL, Vasarhelyi EM. Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes. Canadian Journal of Surgery [Internet]. 2015 Apr 1 [cited 2020 Feb 15];58(2):128–39. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4373995/#b56-0580128
Galia CR, Diesel CV, Guimarães MR, Ribeiro TA. Total hip arthroplasty: a still evolving technique. Revista Brasileira de Ortopedia (English Edition). 2017 Sep;52(5):521–7.
Antonio M, José Sergio Franco, José F, Robson F. Direct lateral and posterolateral approaches for total hip arthroplasty: comparison of postoperative gait... Acta Ortopédica Brasileira [Internet]. 2007 Dec [cited 2024 Oct 4];16(2):74–80. Available from: https://www.researchgate.net/publication/262705045_Direct_lateral_and_posterolateral_approaches_for_total_hip_arthroplasty_comparison_of_postoperative_gait_function
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. A declaração PRISMA 2020: diretriz atualizada para relatar revisões sistemáticas. Revista Panamericana de Salud Pública [Internet]. 2022 Dec 30;46(e112):1. Available from: https://iris.paho.org/bitstream/handle/10665.2/56882/v46e1122022.pdf?sequence=5
Santos CM da C, Pimenta CA de M, Nobre MRC. The PICO strategy for the research question construction and evidence search. Revista Latino-Americana de Enfermagem. 2007 Jun;15(3):508–11.
Mahomed NN, Arndt DC, McGrory BJ, Harris WH. The Harris hip score. The Journal of Arthroplasty. 2001 Aug;16(5):575–80.
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. The Journal of Rheumatology [Internet]. 1988 Dec 1;15(12):1833–40. Available from: https://pubmed.ncbi.nlm.nih.gov/3068365/
McLean JM, Cappelletto J, Jock Clarnette, Hill CL, Gill T, Mandziak D, et al. Normal Population Reference Values for the Oxford and Harris Hip Scores – Electronic Data Collection and its Implications for Clinical Practice. HIP International. 2016 Nov 15;27(4):389–96.
Nilsdotter A, L Stefan Lohmander, Klässbo M, Roos EM. Hip Disability and Osteoarthritis Outcome Score (HOOS)-Validity and Responsiveness in Total Hip Replacement [Internet]. ResearchGate. Springer Nature; 2003. Available from: https://www.researchgate.net/publication/10734224_Hip_Disability_and_Osteoarthritis_Outcome_Score_HOOS-Validity_and_Responsiveness_in_Total_Hip_Replacement
Verhagen AP, de Vet HCW, de Bie RA, Kessels AGH, Boers M, Bouter LM, et al. The Delphi List. Journal of Clinical Epidemiology. 1998 Dec;51(12):1235–41.
Nambiar M, Cheng TE, Onggo JR, Maingard J, Troupis J, Pope A, et al. No Difference in Functional, Radiographic, and Survivorship Outcomes Between Direct Anterior or Posterior Approach THA: 5-Year Results of a Randomized Trial. Clinical Orthopaedics & Related Research. 2021 Jul 12;479:2621–9.
Rykov K., Tim, Bas, Sietsma MS, Reininga IHF, Bas. MRI Assessment of Muscle Damage After the Posterolateral Versus Direct Anterior Approach for THA (Polada Trial). A Randomized Controlled Trial. The Journal of Arthroplasty. 2021 Sep 1;36(9):3248-3258.e1.
Barrett WP, Turner SE, Murphy JA, Flener JL, Alton TB. Prospective, Randomized Study of Direct Anterior Approach vs Posterolateral Approach Total Hip Arthroplasty: A Concise 5-Year Follow-Up Evaluation. The Journal of Arthroplasty. 2019 Jun;34(6):1139–42.
Rabin R, Charro F de. EQ-SD: a measure of health status from the EuroQol Group. Annals of Medicine. 2001 Jan;33(5):337–43.
Steinmetz JD, Culbreth GT, Haile LM, Rafferty Q, Lo J, Fukutaki K, et al. Global, regional, and national burden of osteoarthritis, 1990–2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet Rheumatology. 2023 Sep 1;5(9):e508–22.
Higgins BT, Barlow DR, Heagerty NE, Lin TJ. Anterior vs. Posterior Approach for Total Hip Arthroplasty, a Systematic Review and Meta-analysis. The Journal of Arthroplasty [Internet]. 2015 Mar;30(3):419–34. Available from: https://www.sciencedirect.com/science/article/pii/S0883540314007955?via%3Dihub
Fagotti L, Falotico GG, Maranho DA, Ayeni OR, Einisman B, Cohen M, et al. Posterior versus anterior approach to total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Acta Ortopédica Brasileira. 2021 Dec;29(6):297–303.
