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Is revision total hip arthroplasty through the direct anterior approach feasible?

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

Abstract

Background

To date, only limited literature exists regarding revision of total hip arthroplasty (THA) through the direct anterior approach (DAA). However, as the popularity of the DAA for primary surgery is increasing, surgeons will be confronted with the challenge of performing revision surgery through the DAA. The aim of this study was to review the potential of the DAA in the revision setting and to report the clinical results, radiologic outcomes and complication rates of 63 patients undergoing revision THA through the DAA.

Methods

From 01/2009 to 08/2017, 63 patients underwent revision THA through the DAA. Depending on the performed procedure, patients were separated into 4 groups: liner and head exchange (21 patients), revision of the acetabular cup (26 patients), revision of the femoral stem (13 patients) or revision of both components (3 patients). Postoperative complications as well as the clinical and radiological outcome were assessed retrospectively.

Results

At a mean follow-up of 18 months, the overall complication and re-operation rates were 14.3% and 12.7%, respectively. Specifically, the complication and re-operation rates were 14.2% and 9.5% after liner and head exchange, 15.4% after revision of the acetabular cup, 15.3% after revision of the femoral stem and 0% after revision of both components. The mean postoperative HHS at 1 year postoperatively was 91 (range 74–100).

Conclusion

The DAA offers appropriate exposure for exchange of mobile liners and acetabular cup revision. In selected cases with appropriate stem design, femoral stem revision through the DAA is feasible. However, surgeons should be aware of the technical difficulties related to femoral revision and be prepared to extend the approach distally or perform a trochanteric osteotomy.

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Funding

There is no external funding source, or the funding source did not play a role in the investigation.

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Author notes

  1. Julian Hasler and Andreas Flury contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedics and Traumatology, Bürgerspital Solothurn, Schöngrünstrasse 42, 4500, Solothurn, Switzerland

    Julian Hasler, Andreas Flury, Dimitris Dimitriou, Michael Finsterwald, Naeder Helmy & Alexander Antoniadis

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  1. Julian Hasler
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  2. Andreas Flury
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  3. Dimitris Dimitriou
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Correspondence to Julian Hasler.

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Naeder Helmy has Royalties from Medacta International (Switzerland) and is Speaker for Mathys Ltd Bettlach (Switzerland) and Medacta International (Switzerland).

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Hasler, J., Flury, A., Dimitriou, D. et al. Is revision total hip arthroplasty through the direct anterior approach feasible?. Arch Orthop Trauma Surg 140, 1125–1132 (2020). https://doi.org/10.1007/s00402-020-03469-5

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