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A comparative study of the posterolateral and anterolateral approaches for isolated acetabular revision

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

Although isolated revision of the acetabular component has become an increasingly common option for revision hip surgery, opinions differ regarding the ideal surgical approach for reducing postoperative instability. The purpose of this study was to compare the clinical and radiographic results of isolated acetabular revision performed using a posterolateral and an anterolateral approach.

Materials and methods

The authors retrospectively compared the clinical and radiographic results of isolated acetabular revision performed in 33 hips using a posterolateral approach with those performed in 36 hips using an anterolateral approach. All procedures were performed by a single surgeon and all patients received the same postoperative protocol. Mean duration of follow-up was 4.6 years (range 2–13.2).

Results

Mean postoperative Harris hip scores were similar in the posterolateral and anterolateral groups (86.5 and 87.2 points, respectively). In the entire series of 69 hips, 6 (9%) underwent re-revision of the acetabular component because of aseptic cup loosening in 4, recurrent dislocation in 1, and deep infection in 1. No significant difference was found between the two groups with respect to complication or re-revision rates, but the dislocation rate in the anterolateral approach group was significantly lower than that in the posterolateral group (0 vs. 12%, p = 0.047).

Conclusion

Isolated acetabular revision performed using an anterolateral approach seems to be the more viable option in selected patients, and in particular, it has a significantly lower postoperative dislocation rate than posterolateral acetabular revision.

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References

  1. Berry DJ, Harmsen WS, Cabanela ME, Morrey BF (2002) Twenty-five-year survivorship of two thousand consecutive primary Charnley total hip replacements: factors affecting survivorship of acetabular and femoral components. J Bone Joint Surg Am 84-A:171–177

    PubMed  Google Scholar 

  2. Blom AW, Astle L, Loveridge J, Learmonth ID (2005) Revision of an acetabular liner has a high risk of dislocation. J Bone Joint Surg Br 87:1636–1638

    Article  PubMed  CAS  Google Scholar 

  3. Boucher HR, Lynch C, Young AM, Engh CA Jr, Engh C Sr (2003) Dislocation after polyethylene liner exchange in total hip arthroplasty. J Arthroplasty 18:654–657

    Article  PubMed  Google Scholar 

  4. Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ (2009) The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am 91:128–133

    Article  PubMed  Google Scholar 

  5. Chen XD, Waddell JP, Morton J, Schemitsch EH (2005) Isolated acetabular revision after total hip arthroplasty: results at 5–9 years of follow-up. Int Orthop 29:277–280

    Article  PubMed  Google Scholar 

  6. D’Antonio JA (1992) Periprosthetic bone loss of the acetabulum. Classification and management. Orthop Clin North Am 23:279–290

    PubMed  Google Scholar 

  7. DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 20–32

  8. Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51:737–755

    PubMed  CAS  Google Scholar 

  9. Harris WH (1980) Advances in surgical technique for total hip replacement: without and with osteotomy of the greater trochanter. Clin Orthop Relat Res 188–204

  10. Jamali AA, Dungy DS, Mark A, Schule S, Harris WH (2004) Isolated acetabular revision with use of the Harris-Galante Cementless Component. Study with intermediate-term follow-up. J Bone Joint Surg Am 86-A:1690–1697

    PubMed  Google Scholar 

  11. Jones CP, Lachiewicz PF (2004) Factors influencing the longer-term survival of uncemented acetabular components used in total hip revisions. J Bone Joint Surg Am 86-A:342–347

    PubMed  Google Scholar 

  12. Kim YS, Kim YH, Hwang KT, Choi IY (2009) Isolated acetabular revision hip arthroplasty with the use of uncemented cup. J Arthroplasty 24:1236–1240

    Article  PubMed  Google Scholar 

  13. Lawless BM, Healy WL, Sharma S, Iorio R (2010) Outcomes of isolated acetabular revision. Clin Orthop Relat Res 468:472–479

    Article  PubMed  Google Scholar 

  14. Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. Lancet 370:1508–1519

    Article  PubMed  Google Scholar 

  15. Manning DW, Ponce BA, Chiang PP, Harris WH, Burke DW (2005) Isolated acetabular revision through the posterior approach: short-term results after revision of a recalled acetabular component. J Arthroplasty 20:723–729

    Article  PubMed  Google Scholar 

  16. Martell JM, Pierson RH 3rd, Jacobs JJ, Rosenberg AG, Maley M, Galante JO (1993) Primary total hip reconstruction with a titanium fiber-coated prosthesis inserted without cement. J Bone Joint Surg Am 75:554–571

    PubMed  CAS  Google Scholar 

  17. Moskal JT, Danisa OA, Shaffrey CI (1997) Isolated revision acetabuloplasty using a porous-coated cementless acetabular component without removal of a well-fixed femoral component. A 3- to 9-year follow-up study. J Arthroplasty 12:719–727

    Article  PubMed  CAS  Google Scholar 

  18. O’Brien JJ, Burnett RS, McCalden RW, MacDonald SJ, Bourne RB, Rorabeck CH (2004) Isolated liner exchange in revision total hip arthroplasty: clinical results using the direct lateral surgical approach. J Arthroplasty 19:414–423

    Article  PubMed  Google Scholar 

  19. Paprosky WG, Perona PG, Lawrence JM (1994) Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty 9:33–44

    Article  PubMed  CAS  Google Scholar 

  20. Smith TM, Berend KR, Lombardi AV Jr, Mallory TH, Russell JH (2005) Isolated liner exchange using the anterolateral approach is associated with a low risk of dislocation. Clin Orthop Relat Res 441:221–226

    Article  PubMed  Google Scholar 

  21. Soni RK (1997) An anterolateral approach to the hip joint. Acta Orthop Scand 68:490–494

    Article  PubMed  CAS  Google Scholar 

  22. Suh KT, Roh HL, Moon KP, Shin JK, Lee JS (2008) Posterior approach with posterior soft tissue repair in revision total hip arthroplasty. J Arthroplasty 23:1197–1203

    Article  PubMed  Google Scholar 

  23. Tompkins GS, Jacobs JJ, Kull LR, Rosenberg AG, Galante JO (1997) Primary total hip arthroplasty with a porous-coated acetabular component. Seven-to-ten-year results. J Bone Joint Surg Am 79:169–176

    PubMed  CAS  Google Scholar 

  24. Wade FA, Rapuri VR, Parvizi J, Hozack WJ (2004) Isolated acetabular polyethylene exchange through the anterolateral approach. J Arthroplasty 19:498–500

    Article  PubMed  Google Scholar 

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The authors declare that they have no conflict of interest.

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Correspondence to Seung-Jae Lim.

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Park, YS., Moon, YW., Lim, BH. et al. A comparative study of the posterolateral and anterolateral approaches for isolated acetabular revision. Arch Orthop Trauma Surg 131, 1021–1026 (2011). https://doi.org/10.1007/s00402-011-1258-9

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  • DOI: https://doi.org/10.1007/s00402-011-1258-9

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