Efectividad del abordaje directo anterior versus el abordaje posterior en la artroplastia total de cadera: revisión sistemática

Abstract

Background: Total hip arthroplasty (ATC) is an intervention used to treat degenerative conditions and fractures. The surgical approach influences the functional results. The direct anterior approach (DAA) has gained prominence compared with the posterior approach (PA) for its possible benefits in early recovery, although controversies persist regarding its overall effectiveness. Objective: To compare the effectiveness of DAA versus PA in THA, considering functional recovery, postoperative complications and medium-term results. Methods: A systematic review of studies published between 2014 and 2024 in PubMed, Scopus and SciELO was conducted. Studies with at least 40 patients per group and results on function, complications, or surgical revision were included. Studies without a comparison group, duplicates and gray literature were excluded. The methodological quality was evaluated using NIH and RoB1 tools. Results: The ADA showed lower pain levels, better early HHS and WOMAC scores, and a lower rate of dislocations. However, it presented a higher risk of intraoperative complications, such as fractures and nerve injuries, especially during the learning curve. The PA showed similar long-term functional results, although with a higher incidence of dislocations. Discussion: The ADA offers advantages in early recovery, but requires more technical training and specific resources. The PA has a more stable learning curve. The choice should be individualized according to the patient, the surgeon's experience and the available resources. Conclusions: The ADA provides early functional advantages, although it requires greater surgical skill. The choice of approach must balance efficacy, safety and clinical context. Keywords: direct anterior approach, posterior approach, total hip arthroplasty, surgical complications