Minimally invasive anterolateral approach versus lateral transmuscular approach for total hip arthroplasty: A systematic review and meta-analysis

Background: Total hip arthroplasty (THA) using a minimally invasive (MI) approach is a commonly performed procedure, and several approaches are now being used clinically. The MI anterolateral (MIAL) approach is one of the MI approaches used in clinical practice. Whether the MIAL approach is superior to non-MI approaches remains controversial. To resolve this controversy, we performed a systematic review and a meta-analysis of results of THA procedures that used the MIAL approach. We assessed whether the MIAL approach was superior to the lateral transmuscular (LT) approach in terms of operative time, oper-ative blood loss, radiological parameters, and clinical outcomes. Methods: We performed a methodical search for all literature published on PubMed, Web of Science, and the Cochrane Library, and pooled data using the RevMan software. A p value < 0.05 was considered statistically significant. We calculated the mean differences (MD) for continuous data with 95% confidence intervals (CI) for each outcome. Results: This meta-analysis included 6 studies. Pooled results indicated no statistically significant differences between the groups in terms of operative time (MD = 5.13, 95% CI-2.49 to 12.75, p = 0.19), cup abduction angle (MD = 1.64, 95% CI-1.32 to 4.60, p = 0.28), and cup anteversion angle (MD = 0.75, 95% CI-1.09 to 2.59, p = 0.43). Operative blood loss was significantly greater in those who underwent THA via the MIAL approach than those who underwent THA via the LT approach (MD = 68.01, 95% CI 14.69 to 121.33, p = 0.01). The postoperative Harris hip score (HHS) assessed at the time of final follow-up was signifi-cantly higher in those who underwent THA via the MIAL approach than those who un-derwent THA via the LT approach (MD = 1.41, 95% CI 0.50 to 2.33, p = 0.002). Conclusion: We conclude that the MIAL approach is superior to the LT approach in terms of clinical outcomes. Level of evidence: Level II (c) 2021 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.