Minimally invasive posterior versus direct anterior hip arthroplasty
BMC Musculoskeletal Disorders · 21 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Choosing a hip arthroplasty approach is a common exam and clinic question, and this trial suggests a muscle-sparing posterior approach may bleed less and take less time than DAA in the early perioperative period. Because each approach was done by one surgeon with a different implant system, part of the difference may reflect the surgeon or implant rather than the approach itself.
The evidence
In this single-centre randomised trial, 50 adults with hip osteoarthritis were assigned to total hip replacement through either a minimally invasive posterolateral approach (Mis-PLA) or a direct anterior approach (DAA), each done by a different specialist surgeon using different implants. Intraoperative blood loss was lower with Mis-PLA (157.2 vs 266.0 mL, p = 0.006), and surgery was shorter (61.6 vs 85.6 min). Drain output, transfusions (1/25 vs 3/25), pain scores on days 1 and 3, and length of stay did not differ significantly.
A coherent primary effect estimate is unavailable. Clinical relevance does not estimate treatment benefit.
Why this rigour score?
RCTDesign starting point: 59.5
Raised the score
- Adequately powered+6
- Prospectively registered+5.1
Lowered the score
- Only 1 months of follow-up−5.2
- A positive result from a single centre−4.3
Methods at a glance
Recorded assessment- Outcome assessors blindedNot reported
- Allocation concealedNot reported
- Random sequence generatedMet
- Intention-to-treat analysisNot reported
- Adequate statistical powerMet
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 59.5
- Random sequence generation
- +2.5
- Compared against an accepted alternative
- +1.7
- Only 1 months of follow-up
- −5.2
- 0% loss to follow-up
- +1.7
- Adequately powered
- +6
- Prospectively registered
- +5.1
- A positive result from only 50 patients
- −3.4
- A positive result from a single centre
- −4.3
- Final rigour score rounded
- 64 / 100
Study design sets the starting point and a ceiling of 96. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.When counselling a patient choosing between a minimally invasive posterior approach and a direct anterior approach, how much weight should a roughly 100 mL difference in intraoperative blood loss carry compared with dislocation risk and recovery speed?
2.Which patients, for example those with low preoperative haemoglobin or cardiac disease, might benefit most from an approach that lowers intraoperative blood loss, and how would that change your perioperative blood management plan?
Original publication title
Assessing early perioperative outcomes of minimally invasive posterior approach versus direct anterior approach total hip arthroplasty: a prospective comparative randomized study on blood and pain management