Direct anterior approach for total hip arthroplasty with patients in the lateral decubitus vs supine position: A systematic review and meta-analysis.

Study Summary

5 studies including 375 hips undergoing primary total hip arthroplasty (THA) through the direct anterior approach were included in this systematic review and meta-analysis comparing lateral decubitus with supine positioning. Pooled outcomes included Harris Hip Score (HHS) at 1 month and final follow-up, length of hospital stay, acetabular component inclination and anteversion, leg-length discrepancy, offset, operative time, and blood loss. Functional outcomes and length of stay were similar between positions, while final postoperative component orientation was broadly comparable. Supine positioning provided more consistent fluoroscopic measurements, whereas lateral positioning had femoral exposure and improved operative efficiency in selected patients. Overall, the findings support clinical equivalence rather than superiority of either position.