Which approach of total hip arthroplasty is the best efficacy and least complication?

Table 1 Characteristics of the 28 included meta-analysis studies

Ref.	Last search	Study design	Number of included studies	Sample size	Intervention	Reference	Outcome
Putananon et al[37], 2018	February, 2017	RCT	14	1201	PA/LA/DAA/PA2	PA	HHS, VAS, complications
Higgins et al[6], 2015	February, 2014	RCT & nRCT	17	2302	PA/DAA	PA	HHS, VAS, blood loss, intra-operative fracture, operative time, length of hospital stay, dislocation
Miller et al[34], 2018	June, 2017	RCT & nRCT	13	1044	PA/DAA	PA	HHS, dislocation, intra-operative fracture, wound infection
Wang et al[44], 2018	June, 2018	RCT	9	754	PA/DAA	PA	HHS, VAS, incision length, operative time, length of hospital stay, operative blood loss, intra-operative fracture, dislocation
Miller et al[35], 2018	June, 2017	RCT	7	609	PA/DAA	PA	Incision length, length of hospital stay, operative time, operative blood loss, pain score, complication
Kucukdurmaz et al[30], 2019	January, 2018	RCT & nRCT	17/1	1543	PA/LA/DAA	PA	HHS, operative time, incision length, VAS, neurapraxia, intra-operative fracture, wound infection, dislocation
Jia et al[28], 2019	August, 2016	RCT & nRCT	4/16	7377	PA/DAA	PA	HHS, length of hospital stay, operative time, VAS, dislocation, neurapraxia, intra-operative fracture
Wang et al[43], 2019	October, 2018	RCT	5	475	LA/DAA	LA	HHS, VAS, operative time, operative blood loss, length of hospital stay, complication
Migliorini et al[32], 2021	September, 2019	RCT & nRCT	20/39	10675	PA/LA/DAA	PA	Dislocation, nerve injury, revision
Migliorini et al[33], 2020	October, 2019	RCT & nRCT	13/23	4383	PA/LA/DAA	PA	Length of hospital stay, operative time, operative blood loss
Cha et al[22], 2020	October, 2019	RCT	8	673	PA/LA/DAA	PA	Operative time, Operative blood loss
Peng et al[36], 2020	November, 2019	RCT	7	600	PA/DAA	PA	HHS, VAS, operative time, operative blood loss, length of hospital stay, incision length
Docter et al[24], 2020	June, 2019	RCT & nRCT	19/50	283036	PA/LA/DAA	PA	Dislocation, intra-operative fracture, infection
Yang et al[45], 2020	June, 2019	RCT	11	932	PA/DAA	PA	VAS, neurapraxia, intra-operative fracture, infection, dislocation, operative time, operative blood loss, length of hospital stay
Chen et al[23], 2020	2020	RCT & nRCT	4 /14	34873	PA/DAA	PA	HHS, VAS, operative time, operative blood loss, length of hospital stay, dislocation, intra-operative fracture
Sun et al[42], 2021	June, 2019	RCT & nRCT	3 /6	22698	PA/DAA	PA	HHS, operative time, operative blood loss, length of hospital stay, complication
Awad et al[21], 2021	2021	RCT & nRCT	7/22	8576	PA/DAA	PA	HHS, operative time, operative blood loss, length of hospital stay, complication
Huerfano et al[27], 2021	2021	RCT & nRCT	5/20	7172	PA/DAA/	PA	Dislocation
Gazendam et al[25], 2022	2021	RCT	25	2339	PA/LA/ALA/DAA	PA	HHS, VAS, length of hospital stay, complication
Ge et al[26], 2021	2021	RCT & nRCT	3/3	526	DSA/SuperPath/PA	PA	HHS, operative time, operative blood loss, incision length, VAS, length of hospital stay
Joseph et al[29], 2023	2022	RCT	7	730	DSA/SuperPath/PA	PA	HHS, operative time, operative blood loss, incision length, VAS, length of hospital stay, complication
Lazaru et al[31], 2021	2021	RCT	9	998	DAA/PA	PA	HHS, operative time, operative blood loss, incision length, VAS
O’connor et al[105], 2021	2021	No RCT	15	1872	DAA/non-DAA	PA, ALA, LA	Infection
Ramadanov et al[39], 2021	2021	RCT	16	1392	DSA/SuperPath/DAA/PA	PA	HHS, operative time, operative blood loss, incision length, VAS
Ramadanov et al[40], 2021	2021	RCT	24	2074	DSA/SuperPath/DAA/PA	PA	HHS, operative time, operative blood loss, incision length, VAS, complication
Ramadanov et al[41], 2022	2022	RCT	20	1501	SuperPath/DAA/PA	PA	HHS, operative time, operative blood loss, incision length
Ramadanov et al[38], 2022	2022	RCT	14	1021	SuperPath/PA	PA	HHS, operative time, operative blood loss, incision length, VAS, complication
Zhou et al[46], 2022	2022	RCT	15	1450	DAA/PA/LA	PA, LA	HHS, operative time, length of hospital stay, complication
Ang et al[20], 2023	2023	RCT	24	2010	DAA/LA/PA	PA	HHS, operative time, length of hospital stay, complication

RCT: Randomized controlled trial; nRCT: Not randomized controlled trial; HHS: Harris hip score; VAS: Visual analog scale; PA: Posterior approach; LA: Lateral approach; DAA: Direct anterior approach; 2-incision: 2 incisions approach; LMIS: Mini-lateral approach; ALA: Anterolateral approach; DSA/SuperPath: Direct superior approach or Supercapsular percutaneously-assisted total hip.

Table 2 Characteristics of included 47 randomized controlled trials

Ref.	Country	Mean age	BMI	Male (%)	ASA	F/U (wk)	Diagnosis (% OA)	Intervention
Li et al[68], 2021	China	76.35	22.85	53.13	NR	NR	NR	DSA/SuperPath vs PA
Ulivi et al[18], 2021	Italy	72.98	23.51	37.78	NR	26	NR	DSA/SuperPath vs PA
Meng et al[19], 2021	China	64.90	23.09	42.50	2.35	52	NR	DSA/SuperPath vs PA
Rykov et al[84], 2021	Netherlands	62.50	28.20	41.30	1.59	52	NR	DAA vs PA
Cao et al[56], 2020	China	61.90	24.90	42.31	NR	26	NR	DAA vs PA
Nistor et al[76], 2020	Romania	62.63	28.15	41.07	NR	52	NR	DAA vs LA
Meng et al[73], 2019	China	51.00	21.49	100.00	1.66	52	NR	DSA/SuperPath vs PA
Wang et al[91], 2019	China	55.39	23.09	59.26	NR	52	100.00	LA vs PA
Moerenhout et al[75], 2020	Switzerland	69.66	27.10	52.73	1.90	260	NR	DAA vs PA
Li et al[67], 2019	China	62.00	23.26	73.33	NR	26	42.00	DAA vs LA
Bon et al[54], 2019	France	68.12	26.58	44.00	NR	NR	100.00	DAA vs PA
Ouyang et al[78], 2018	China	56.00	23.19	70.83	2.21	NR	20.83	DSA/SuperPath vs PA
Zomar et al[97], 2018	Canada	60.11	29.73	52.56	NR	12	100.00	DAA vs LA
Taunton et al[88], 2018	United States	64.51	29.48	51.00	NR	52	100.00	DAA vs PA
Brismar et al[55], 2018	Sweden	66.75	26.88	35.00	1.61	NR	51.00	DAA vs LA
Reichert et al[81], 2018	Germany	62.58	28.20	NR	NR	NR	100.00	DAA vs LA
Takada et al[86], 2018	Japan	62.60	24.40	13.33	NR	NR	100.00	DAA vs LA
Xie et al[93], 2017	China	65.54	23.84	66.30	NR	52	100.00	DSA/SuperPath vs PA
Cheng et al[57], 2017	Australia	61.28	28.01	45.20	1.96	12	100.00	DAA vs PA
Xu et al[94], 2017	China	58.27	24.49	60.92	NR	NR	NR	DAA vs PA
Nistor et al[77], 2017	Romania	63.75	28.04	40.00	NR	NR	100.00	DAA vs LA
Rosenlund et al[83], 2017	Denmark	61.03	27.51	65.00	1.32	52	NR	LA vs PA
Rykov et al[85], 2017	Netherlands	NR	NR	NR	NR	NR	84.80	DAA vs PA
Zhao et al[96], 2017	China	63.53	NR	NR	NR	NR	NR	DAA vs PA
Anta-Díaz et al[59], 2016	Spain	64.14	26.75	52.52	NR	52	100.00	DAA vs LA
Parvizi et al[79], 2016	United States	NR	NR	NR	NR	NR	100.00	DAA vs LA
Luo et al[69], 2016	China	NR	NR	NR	NR	NR	NR	LA vs PA
Christensen et al[58], 2015	United States	64.71	30.78	47.10	NR	NR	NR	DAA vs PA
Mjaaland et al[74], 2015	Norway	66.42	27.65	33.50	1.85	NR	100.00	DAA vs LA
Vicente et al[90], 2015	Brazil	55.94	27.38	55.36	NR	24	52.68	LA vs PA
Dienstknecht et al[61], 2014	Germany	61.53	29.14	44.06	2.26	NR	100.00	DAA vs LA
Taunton et al[87], 2014	United States	64.23	28.45	46.30	NR	52	NR	DAA vs PA
Landgraeber et al[66], 2013	Germany	70.66	26.90	34.21	2.06	156	100.00	LMIS vs LA
Barrett et al[53], 2013	United States	62.31	29.89	55.20	NR	52	NR	DAA vs PA
Ji et al[65], 2012	S. Korea	51.49	24.30	57.10	NR	150	37.20	LA vs PA
Martin et al[70], 2011	Belgium	64.92	30.00	31.33	2.14	52	Most	LMIS vs LA
Goosen et al[63], 2011	Netherlands	62.00	26.45	48.30	NR	NR	NR	LA vs PA
Pospischill et al[80], 2010	Austria	61.25	25.70	50.00	NR	12	100.00	LMIS vs LA
Yang et al[95], 2010	China	57.78	22.77	50.91	NR	NR	20	LA vs PA
Della Valle et al[60], 2010	United States	62.46	27.45	31.90	2.06	NR	100.00	2-incision vs PA
Restrepo et al[82], 2010	United States	59.95	25.18	39.39	2.13	NR	NR	DAA vs LA
Mayr et al[71], 2009	Switzerland	68.02	27.99	42.42	NR	NR	NR	DAA vs LA
Meneghini et al[72], 2009	United States	54.00	26.00	NR	NR	NR	NR	2-incision vs LA vs PA
Witzleb et al[92], 2009	Germany	55.88	27.75	48.33	NR	12	56.70	LA vs PA
Yan et al[89], 2017	China	65.42	23.97	46.10	NR	60	NR	SuperPath vs LA
Yuan et al[64], 2018	China	75.03	22.54	55.56	NR	72	NR	SuperPath vs PA
Dongwei et al[62], 2016	China	58.21	NR	NR	NR	12	100.00	SuperPath vs LA

RCT: Randomized controlled trial; BMI: Body mass index (kg/m²); OA: Osteoarthritis; NR: Not reported; PA: Posterior approach; LA: Lateral approach; DAA: Direct anterior approach; 2-incision: 2 incisions approach; LMIS: Mini-lateral approach; DSA/SuperPath: Direct superior approach or Supercapsular percutaneously assisted total hip.

Table 3 Network meta-analysis results of primary outcomes

Risk ratio/unstandardized mean difference (95%CI)
	PA	LA	DAA	2-incision	LMIS	DSA/SuperPath
HHS ≤ 3 mo
PA	[27.4; 0.0]	0.74 (-2.24, 3.72)	3.49 (0.98, 6.00)	0.83 (-7.50, 9.16)	0.02 (-10.13, 10.17)	1.57 (-1.55, 4.69)
LA	-0.74 (-3.72, 2.24)	[42.7; 0.5]	2.75 (-0.02, 5.52)	0.09 (-8.64, 8.81)	-0.72 (-10.43, 8.99)	0.83 (-2.91, 4.57)
DAA	-3.49 (-6.00, -0.98)	-2.75 (-5.52, 0.02)	[85.9; 47.5]	-2.66 (-11.31, 5.99)	-3.47 (-13.56, 6.63)	-1.92 (-5.67, 1.83)
2-incision	-0.81 (-13.86, 12.24)	-0.09 (-8.81, 8.64)	2.66 (-5.99, 11.31)	[45.5; 20.7]	-0.81 (-13.86, 12.24)	0.74 (-8.12, 9.61)
LMIS	-0.02 (-10.17, 10.13)	0.72 (-8.99, 10.43)	3.47 (-6.63, 13.56)	0.81 (-12.24, 13.86)	[41.0; 22.1]	1.55 (-8.85, 11.95)
DSA/SuperPath	-1.57 (-4.69, 1.55)	-0.83 (-4.57, 2.91)	1.92 (-1.83, 5.67)	-0.74 (-9.61, 8.12)	-1.55 (-11.95, 8.85)	[57.6; 9.2]
HHS 6 mo
PA	[42.2; 3.0]	-0.21 (-1.67, 1.25)	0.22 (-0.95, 1.39)	1.85 (-14.14, 17.84)	NR	0.35 (-0.84, 1.53)
LA	0.21 (-1.25, 1.67)	[33.2; 4.1]	0.43 (-1.50, 2.36)	2.06 (-13.94, 18.05)	NR	0.55 (-0.88, 1.98)
DAA	-0.22 (-1.39, 0.95)	-0.43 (-2.36, 1.50)	[55.9; 19.3]	1.63 (-14.41, 17.67)	NR	0.13 (-1.62, 1.87)
2-incision	-1.85 (-17.84, 14.14)	-2.06 (-18.05, 13.94)	-1.63 (-17.67, 14.41)	[57.6; 55.2]	NR	-1.50 (-17.52, 14.51)
LMIS	NR	NR	NR	NR	NR	NR
DSA/SuperPath	-0.35 (-1.53, 0.84)	-0.55 (-1.98, 0.88)	-0.13 (-1.87, 1.62)	1.50 (-14.51, 17.52)	NR	[61.1; 18.4]
HHS 1 yr
PA	[27.5; 0.0]	0.60 (-0.55, 1.74)	1.76 (1.12, 2.40)	-1.93 (-4.95, 1.08)	1.43 (-2.16, 5.02)	0.42 (-0.28, 1.12)
LA	-0.60 (-1.74, 0.55)	[54.8; 0.0]	1.17 (0.20, 2.14)	-2.53 (-5.75, 0.69)	0.83 (-2.57, 4.23)	-0.18 (-1.52, 1.17)
DAA	-1.76 (-2.40, -1.12)	-1.17 (-2.14, -0.20)	[90.7; 55.4]	-3.70 (-6.78, -0.62)	-0.34 (-3.87, 3.20)	-1.34 (-2.29, -0.39)
2-incision	1.93 (-1.08, 4.95)	2.53 (-0.69, 5.75)	3.70 (0.62, 6.78)	[6.0; 0.6]	3.36 (-1.32, 8.04)	2.35 (-0.74, 5.45)
LMIS	-1.43 (-5.02, 2.16)	-0.83 (-4.23, 2.57)	0.34 (-3.20, 3.87)	-3.36 (-8.04, 1.32)	[70.8; 43.7]	-1.01 (-4.66, 2.65)
DSA/SuperPath	-0.42 (-1.12, 0.28)	0.18 (-1.17, 1.52)	1.34 (0.39, 2.29)	-2.35 (-5.45, 0.74)	1.01 (-2.65, 4.66)	[50.2; 0.3]
Dislocation
PA	[50.8; 8.6]	1.01 (0.34, 2.97)	0.90 (0.52, 1.57)	NR	1.00 (0.08, 11.81)	1.28 (0.29, 5.57)
LA	0.99 (0.34, 2.94)	[49.8; 15.2]	0.90 (0.29, 2.74)	NR	0.99 (0.11, 9.14)	1.27 (0.20, 7.90)
DAA	1.11 (0.64, 1.92)	1.11 (0.37, 3.40)	[61.5; 21.9]	NR	1.11 (0.09, 13.27)	1.41 (0.29, 6.82)
2-incision	NR	NR	NR	NR	NR	NR
LMIS	1.00 (0.08, 11.85)	1.01 (0.11, 9.28)	0.90 (0.08, 10.85)	NR	[50.9; 37.3]	1.28 (0.07, 22.70)
DSA/SuperPath	0.78 (0.18, 3.42)	0.79 (0.13, 4.90)	0.71 (0.15, 3.41)	NR	0.78 (0.04, 13.88)	[37.2; 17.0]
Intra-operative fracture
PA	[67.3; 17.2]	1.33 (0.49, 3.58)	0.96 (0.36, 2.57)	1.84 (0.19, 18.35)	2.19 (0.22, 21.84)	1.75 (0.37, 8.35)
LA	0.75 (0.28, 2.02)	[49.0; 6.6]	0.72 (0.26, 1.95)	1.39 (0.12, 15.36)	1.65 (0.21, 13.12)	1.31 (0.21, 8.36)
DAA	1.05 (0.39, 2.82)	1.39 (0.51, 3.78)	[70.7; 30.3]	1.93 (0.17, 22.48)	2.29 (0.23, 22.94)	1.83 (0.29, 11.65)
2-incision	0.54 (0.05, 5.39)	0.72 (0.07, 8.00)	0.52 (0.04, 6.03)	[41.5; 19.9]	1.19 (0.05, 28.49)	0.95 (0.06, 15.27)
LMIS	0.46 (0.05, 4.55)	0.61 (0.08, 4.84)	0.44 (0.04, 4.36)	0.84 (0.04, 20.20)	[33.6; 15.1]	0.80 (0.05, 12.88)
DSA/SuperPath	0.57 (0.12, 2.73)	0.76 (0.12, 4.84)	0.55 (0.09, 3.47)	1.05 (0.07, 16.97)	1.25 (0.08, 20.20)	[37.9; 10.9]

Values are the risk ratio 95% confidence interval (95%CI) of dichotomous outcomes (dislocation and intra-operative fracture) or the mean difference (95%CI) of continuous outcomes comparing surgical intervention in column with surgical intervention in row (reference). Values of diagonal line in square brackets are surface under the cumulative ranking curve area and probability of being best surgical approaches (highest HHS and low risk of dislocation, intra-operative fracture). HHS: Harris Hip Score; PA: Posterior approach; LA: Lateral approach; DAA: Direct anterior approach; 2-incision: 2 incisions approach; LMIS: Mini-lateral approach; DSA/SuperPath: Direct superior approach or Supercapsular percutaneously-assisted total hip; NR: Not reported.

Table 4 Network meta-analysis results of secondary outcomes

Risk ratio/Unstandardized mean difference (95%CI)
	PA	LA	DAA	2 incisions	LMIS	DSA/SuperPath
Operative time
PA	[98.6; 93.2]	10.38 (2.04, 18.71)	15.38 (8.64, 22.12)	21.00 (-4.27, 46.27)	23.86 (4.25, 43.47)	18.74 (9.69, 27.79)
LA	-10.38 (-18.71, -2.04)	[70.7; 0.7]	5.01 (-2.66, 12.68)	10.62 (-15.99, 37.24)	13.49 (-4.26, 31.23)	8.36 (-3.12, 19.84)
DAA	-15.38 (-22.12, -8.64)	-5.01 (-12.68, 2.66)	[46.0; 0.0]	5.62 (-20.54, 31.78)	8.48 (-10.86, 27.81)	3.35 (-7.58, 14.29)
2-incision	-21.00 (-46.27, 4.27)	-10.62 (-37.24, 15.99)	-5.62 (-31.78, 20.54)	[33.8; 5.3]	2.86 (-29.13, 34.85)	-2.26 (-29.11, 24.58)
LMIS	-23.86 (-43.47, -4.25)	-13.49 (-31.23, 4.26)	-8.48 (-27.81, 10.86)	-2.86 (-34.85, 29.13)	[19.6; 0.8]	-5.12 (-26.26, 16.01)
DSA/SuperPath	-18.74 (-27.79, -9.69)	-8.36 (-19.84, 3.12)	-3.35 (-14.29, 7.58)	2.26 (-24.58, 29.11)	5.12 (-16.01, 26.26)	[31.4; 0.0]
Length of hospital stay
PA	[45.5; 0.0]	0.52 (-0.36, 1.39)	-0.21 (-0.84, 0.43)	0.11 (-1.29, 1.51)	0.32 (-2.12, 2.76)	-1.56 (-2.44, -0.69)
LA	-0.52 (-1.39, 0.36)	[16.9; 0.0]	-0.72 (-1.52, 0.07)	-0.41 (-1.92, 1.10)	-0.20 (-2.48, 2.08)	-2.08 (-3.12, -1.04)
DAA	0.21 (-0.43, 0.84)	0.72 (-0.07, 1.52)	[61.3; 0.7]	0.31 (-1.17, 1.80)	0.52 (-1.89, 2.94)	-1.36 (-2.36, -0.35)
2-incision	-0.11 (-1.51, 1.29)	0.41 (-1.10, 1.92)	-0.31 (-1.80, 1.17)	[42.6; 3.0]	0.21 (-2.52, 2.94)	-1.67 (-3.28, -0.06)
LMIS	-0.32 (-2.76, 2.12)	0.20 (-2.08, 2.48)	-0.52 (-2.94, 1.89)	-0.21 (-2.94, 2.52)	[35.8; 6.3]	-1.88 (-4.38, 0.62)
DSA/SuperPath	1.56 (0.69, 2.44)	2.08 (1.04, 3.12)	1.36 (0.35, 2.36)	1.67 (0.06, 3.28)	1.88 (-0.62, 4.38)	[97.9; 90.0]
Incision length
PA	[4.0; 0.0]	-1.53 (-3.86, 0.81)	-2.54 (-4.64, -0.45)	NR	-3.42 (-7.99, 1.16)	-5.15 (-7.29, -3.01)
LA	1.53 (-0.81, 3.86)	[31.1; 0.0]	-1.02 (-3.00, 0.96)	NR	-1.89 (-5.82, 2.04)	-3.62 (-6.52, -0.72)
DAA	2.54 (0.45, 4.64)	1.02 (-0.96, 3.00)	[55.4; 1.8]	NR	-0.87 (-5.27, 3.53)	-2.60 (-5.45, 0.24)
2-incision	NR	NR	NR	NR	NR	NR
LMIS	3.42 (-1.16, 7.99)	1.89 (-2.04, 5.82)	0.87 (-3.53, 5.27)	NR	[66.5; 24.5]	-1.73 (-6.62, 3.16)
DSA/SuperPath	5.15 (3.01, 7.29)	3.62 (0.72, 6.52)	2.60 (-0.24, 5.45)	NR	1.73 (-3.16, 6.62)	[92.9; 73.7]
Operative blood loss
PA	[61.6; 10.7]	-25.66 (-117.26, 65.95)	23.03 (-56.18, 102.24)	46.00 (-185.02, 277.02)	59.67 (-177.38, 296.72)	23.02 (-56.58, 102.62)
LA	25.66 (-65.95, 117.26)	[75.9; 35.1]	48.69 (-47.77, 145.15)	71.66 (-176.86, 320.18)	85.33 (-133.30, 303.96)	48.68 (-62.19, 159.55)
DAA	-23.03 (-102.24, 56.18)	-48.69 (-145.15, 47.77)	[44.0; 5.6]	22.97 (-221.26, 267.19)	36.64 (-202.33, 275.61)	-0.01 (-108.84, 108.82)
2-incision	-46.00 (-277.02, 185.02)	-71.66 (-320.18, 176.86)	-22.97 (-267.19, 221.26)	[41.9; 24.3]	13.67 (-317.33, 344.68)	-22.98 (-267.33, 221.37)
LMIS	-59.67 (-296.72, 177.38)	-85.33 (-303.96, 133.30)	-36.64 (-275.61, 202.33)	-13.67 (-344.68, 317.33)	[34.4; 17.5]	-36.65 (-281.79, 208.49)
DSA/SuperPath	-23.02 (-102.62, 56.58)	-48.68 (-159.55, 62.19)	0.01 (-108.82, 108.84)	22.98 (-221.37, 267.33)	36.65 (-208.49, 281.79)	[42.2; 6.8]
Wound complication
PA	[70.0; 16.2]	2.26 (0.72, 7.06)	1.31 (0.59, 2.88)	0.80 (0.04, 18.03)	5.45 (0.60, 49.61)	1.00 (0.15, 6.79)
LA	0.44 (0.14, 1.38)	[31.0; 0.9]	0.58 (0.18, 1.87)	0.36 (0.02, 7.11)	2.41 (0.36, 16.00)	0.44 (0.05, 4.11)
DAA	0.77 (0.35, 1.69)	1.73 (0.53, 5.62)	[54.8; 5.2]	0.62 (0.03, 14.29)	4.18 (0.45, 38.77)	0.77 (0.10, 6.09)
2-incision	1.24 (0.06, 27.95)	2.81 (0.14, 56.24)	1.62 (0.07, 37.72)	[68.8; 46.2]	6.79 (0.20, 234.54)	1.24 (0.03, 48.08)
LMIS	0.18 (0.02, 1.67)	0.41 (0.06, 2.75)	0.24 (0.03, 2.22)	0.15 (0.00, 5.09)	[12.5; 1.3]	0.18 (0.01, 3.41)
DSA/SuperPath	1.00 (0.15, 6.79)	2.26 (0.24, 20.99)	1.31 (0.16, 10.38)	0.80 (0.02, 31.03)	5.45 (0.29, 101.44)	[62.8; 30.2]
Nerve injury
PA	[79.7; 25.6]	2.97 (0.89, 9.97)	9.82 (3.06, 31.58)	18.97 (2.41, 149.62)	1.08 (0.11, 10.20)	1.00 (0.02, 49.35)
LA	0.34 (0.10, 1.13)	[49.4; 0.5]	3.30 (1.22, 8.94)	6.38 (0.81, 50.31)	0.36 (0.05, 2.41)	0.34 (0.01, 19.93)
DAA	0.10 (0.03, 0.33)	0.30 (0.11, 0.82)	[17.9; 0.0]	1.93 (0.22, 16.92)	0.11 (0.01, 0.93)	0.10 (0.00, 5.96)
2-incision	0.05 (0.01, 0.42)	0.16 (0.02, 1.24)	0.52 (0.06, 4.54)	[9.0; 0.2]	0.06 (0.00, 0.94)	0.05 (0.00, 4.35)
LMIS	0.93 (0.10, 8.81)	2.76 (0.41, 18.42)	9.13 (1.07, 77.77)	17.63 (1.07, 291.08)	[75.1; 31.9]	0.93 (0.01, 83.77)
DSA/SuperPath	1.00 (0.02, 49.35)	2.97 (0.05, 176.30)	9.82 (0.17, 575.31)	18.97 (0.23, 1564.11)	1.08 (0.01, 97.00)	[69.0; 41.8]

Values are the risk ratio (95% confidence interval; 95%CI) of dichotomous outcomes (wound complication and nerve injury) or the mean difference (95%CI) of continuous outcomes [operative time (min), length of hospital stay (d), incision length (cm), operative blood loss (mL) comparing surgical interventions in column with surgical intervention in row (reference)]; Values of diagonal line in square brackets are surface under the cumulative ranking curve area and probability of being best surgical approaches (lowest operative time, length of hospital stay, incision length, operative blood loss and low risk of wound complication, nerve injury). PA: Posterior approach; LA: Lateral approach; DAA: Direct anterior approach; 2-incision: 2 incisions approach; LMIS: Mini-lateral approach; DSA/SuperPath: Direct superior approach or Supercapsular percutaneously-assisted total hip; NR: Not report.