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There is still discussion about possible advantages and disadvantages of the less invasive anterior approach for total hip arthroplasty (THA). The purpose of our systematic review was to evaluate literature regarding the anterior approach in comparison to other approaches. Furthermore, we investigated if there is a description of a learning curve for the anterior approach.Data were obtained from EMBASE, Cochrane, PsycINFO, CINAHL, Web-of-Science, Scopus, Google scholar, and PubMed since their inception up to June 2015. 2 reviewers independently selected the studies and independently conducted the quality assessment. Because studies were considered heterogeneous regarding outcome measures, determinants studied, and methodological quality, we decided to perform a "best evidence synthesis". A total of 64 studies met the inclusion criteria.Strong evidence for no difference in component placement between the anterior approach and other approaches was found. Also, strong evidence for faster postoperative recovery and less need for assistive devices after the anterior approach were found. All other studied parameters only demonstrated conflicting evidence. Although the learning curve for the anterior approach is not yet clear, this learning curve should not to be neglected.In conclusion, the less invasive anterior approach provides benefits in the early postoperative period only, when compared to other approaches.

This study describes specific complications noticed during the first unselected cases operated by anterior approach for THA in our hospital and specific adjustments that were applied on the procedure to prevent these complications. We retrospectively analysed the differences between 202 patients who were operated by a standardised approach and 248 patients who were operated after adjustments were implemented with the procedure. Injury to the lateral femoral cutaneous nerve (LFCN), fractures of the greater trochanter and dislocation were specific complications that were noticed with the initial technique.Prevalence of injury to the LFCN decreased from 7.9% to 0.8% (p<0.001), fractures of the greater trochanter decreased from 5.4% to 0.8% (p = 0.004) and the incidence of dislocation decreased from 4.5% to 1.6% (p = 0.074).