This 2015 systematic review and meta-analysis compared anterior versus posterior approach for primary THA across 17 studies and 2302 patients. It asked whether the anterior approach produces meaningfully better clinical, radiographic, or surgical outcomes than the posterior approach. The review was conducted using Cochrane Handbook methodology and PRISMA reporting standards.
Before this review, the anterior approach was gaining rapid popularity based on preliminary series and patient-driven demand, with claims of faster recovery, less pain, and lower dislocation rates — but no systematic synthesis had tested these claims against the posterior approach.
This paper is why we counsel patients that the anterior approach offers modest early advantages (shorter stay, lower early pain scores, possibly lower dislocation risk), but no proven long-term superiority. When a patient asks whether the anterior approach will give them better outcomes at one year, the honest answer from this data is: probably not.
The one durable finding worth remembering: dislocation risk was statistically lower with the anterior approach (OR 0.29). For a patient at elevated dislocation risk. Prior hip surgery, neurologic dysfunction, obesity. This may tip the decision toward the anterior approach if the surgeon has the experience.
Approach selection should ultimately rest on surgeon experience and patient factors, not marketing. A high-volume posterior surgeon will outperform a novice anterior surgeon on every metric that matters.
This 2015 systematic review and meta-analysis compared anterior versus posterior approach for primary THA across 17 studies and 2302 patients. It asked whether the anterior approach produces meaningfully better clinical, radiographic, or surgical outcomes than the posterior approach. The review was conducted using Cochrane Handbook methodology and PRISMA reporting standards.
Before this review, the anterior approach was gaining rapid popularity based on preliminary series and patient-driven demand, with claims of faster recovery, less pain, and lower dislocation rates — but no systematic synthesis had tested these claims against the posterior approach.
This paper is why we counsel patients that the anterior approach offers modest early advantages (shorter stay, lower early pain scores, possibly lower dislocation risk), but no proven long-term superiority. When a patient asks whether the anterior approach will give them better outcomes at one year, the honest answer from this data is: probably not.
The one durable finding worth remembering: dislocation risk was statistically lower with the anterior approach (OR 0.29). For a patient at elevated dislocation risk. Prior hip surgery, neurologic dysfunction, obesity. This may tip the decision toward the anterior approach if the surgeon has the experience.
Approach selection should ultimately rest on surgeon experience and patient factors, not marketing. A high-volume posterior surgeon will outperform a novice anterior surgeon on every metric that matters.