Complications - Other
The Direct Anterior Approach is Associated With Early Revision Total Hip Arthroplasty

https://doi.org/10.1016/j.arth.2016.09.012Get rights and content

Abstract

Background

The direct anterior approach for total hip arthroplasty (THA) has generated increased interest recently. The purpose of this study was to compare the duration to failure and reasons for revision of primary THA performed elsewhere and subsequently revised at our institution after the direct anterior vs other nonanterior surgical approaches to the hip.

Methods

All primary THAs performed elsewhere and referred to our institution for revision were divided into the direct anterior approach (30 cases) or nonanterior approach groups (100 cases, randomly selected from 453 cases) based on the original surgical approach. Because all primary direct anterior THAs were originally performed after 2004 to eliminate temporal bias, we identified a subset of the nonanterior group in which the primary THA was performed after 2004 (known as the recent nonanterior group, 100 cases, randomly selected from 169 available cases).

Results

The mean duration from primary to revision THA was 3.0 ± 2.7 years (direct anterior approach), 12.0 ± 8.8 years (nonanterior approach), and 3.6 ± 2.8 years (recent nonanterior), respectively. There was a significant difference in time to revision between the direct anterior and nonanterior approach groups (P < .001). Aseptic loosening of the stem was significantly more frequent with the direct anterior approach group (9/30, 30.0%) when compared with the nonanterior group (8/100, 8.0%, P = .007) and the recent nonanterior group (7/100, 7.0%, P = .002).

Conclusion

Revision of the femoral component for aseptic loosening is more commonly associated with the direct anterior approach in our referral practice.

Section snippets

Patients and Methods

We retrospectively reviewed our institutional database for revision THAs performed by three attending surgeons from January 2005 to December 2015. Eight hundred eighty-seven revision THAs were performed at our institution during this period. Revision THAs performed at our institution in which the primary THA was performed at an outside hospital were identified and included in this report. The other 404 revision THAs (including rerevision THAs, nonreferred patients, conversions of

Results

There were no differences in the demographic data or reasons for revision within the nonanterior or the recent nonanterior groups when considering whether patients underwent an anterolateral or a posterior approach; thus these two surgical approaches were combined within the nonanterior and the recent nonanterior groups. Table 1 shows demographic data of the patients in the direct anterior, nonanterior, and recent nonanterior groups. There were no significant differences among these three

Discussion

Although the number of primary THAs using the direct anterior approach is increasing, few articles have investigated the relationship between surgical approaches and subsequent cause for revision or revision rate 4, 20, 21, 22. The direct anterior approach has been reported to be comparable with other approaches with respect to revision rate [4]. The innovative aspects and complications associated with different surgical approaches, especially the direct anterior approach, are controversial.

Conclusion

The direct anterior surgical approach is associated with a shorter time to referral to our tertiary care practice for revision surgery, when compared with other conventional surgical approaches (posterior and anterolateral) for THA. Furthermore, revision of the femoral component has become relatively more common after the direct anterior surgical approach for cases referred to our practice.

References (30)

  • J.T. Moskal et al.

    Anterior muscle sparing approach for total hip arthroplasty

    World J Orthop

    (2013)
  • D. Sheth et al.

    Anterior and anterolateral approaches for THA are associated with lower dislocation risk without higher revision risk

    Clin Orthop Relat Res

    (2015)
  • V. Klausmeier et al.

    Is there faster recovery with an anterior or anterolateral THA? A pilot study

    Clin Orthop Relat Res

    (2010)
  • B.A. Jewett et al.

    High complication rate with anterior total hip arthroplasties on a fracture table

    Clin Orthop Relat Res

    (2011)
  • C. Yi et al.

    Early complications of anterior supine intermuscular total hip arthroplasty

    Orthopedics

    (2013)
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    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.09.012.

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