Early return to activity of daily living after total hip arthroplasty: a systematic review and meta-analysis

Background: Total hip arthroplasty (THA) is an orthopaedic procedure that improves the quality of life in patients suffering from hip pain related to osteoarthritis, fractures, and avascular osteonecrosis of the femoral head. Different surgical approaches can be used for THA leading to different recovery times. Because of the lowering medium age of people undergoing THA, it is important to focus on the earlier return of physiological activity after surgery. Aim: To evaluate the best approach for THA in terms of earlier return to activity. Method: Studies comparing the postoperative outcomes in patients who underwent THA through different approaches were analysed focusing on patients’ self-reported outcomes, ADL score and UCLA activity score with a short follow-up. Results: A total of 1990 articles were identified in the search, and 14 met the inclusion criteria. The Review Manager software version 5.4 was used to conduct a meta-analysis to compare the direct anterior (DAA) and posterior (PA) approaches, which are the most adopted approaches. An earlier return to walk without aids and to independent ADLs were reported with DAA, but without statistical significance (respectively p = 0.06 and p = 0.10). The time to return to drive was similar among the 2 groups ( p = 0.88). The return to work was faster with PA, but no statistical significance was reported ( p = 0.47). Conclusions: Further studies are needed with a larger number of patients, that present homogeneous outcomes, follow-ups and rehabilitation programmes, and that compare similar surgical approaches to assess the early return to activity of daily living after THA.