Evaluation of Direct Anterior Approach for Revision Total Hip Arthroplasty: A Systematic Review

Overview

Journal Hip Pelvis

Date 2021 Sep 23

PMID 34552888

Citations 5

Authors

Gurvinder Singh

Ankit Khurana

Shailendra Gupta

Affiliations

Soon will be listed here.

Abstract

The direct anterior approach (DAA) is an established approach for total hip arthroplasty (THA) but has been sparingly tried for revisions. The purpose of this study was to examine the available literature in order to consolidate information available on revision THA using the DAA. A PubMed, Embase, and Scopus search was performed using relevant keywords. Studies reporting on patients undergoing revision THA using DAA were included for analysis. In a review of the literature, nine studies matched the pre-decided inclusion criteria with 319 hip joints undergoing revision THA. Mean follow-up of all included studies was 34 months. The indications of revision after primary THA in decreasing order were aseptic loosening (53%), prosthetic joint infection (20.7%), peri-prosthetic fracture (16.9%), dislocation (7.2%), psoas impingement (1.9%), polyethylene wear (1.2%), pain (0.6%), and instability (0.3%). Of the 319 revisions evaluated, 107 underwent a stem revision, 142 underwent cup revision, 49 underwent a combined revision, and 21 underwent isolated liner/head change. A statistically significant improvement in functional score (<0.05) was observed for all studies reporting on functional outcomes. A low complication rate (51/319, 16.0%), which includes dislocation (12), infection (12), loosening of the acetabular shell (5), peri-prosthetic fractures (6), haematoma (4), and transient nerve palsy (6), was reported. Based on available level III-IV evidence, DAA appears to be a reliable alternative for revision of the failed hip arthroplasty with acceptable complication rates. Evidence of a higher quality is needed to further characterize its role in revision scenarios.

Citing Articles

A systematic review on revision total hip arthroplasty employing the direct anterior approach.

Peters C, Dopson E, Ross J, Goldman A Arch Orthop Trauma Surg. 2024; 145(1):69.

PMID: 39694949 DOI: 10.1007/s00402-024-05727-2.

Efficacy of direct anterior approach versus posterolateral approach in total hip arthroplasty: a systematic review and meta-analysis.

Wang K, Zhang T, Xia R, Wang J, Yu J, Wang W Arch Orthop Trauma Surg. 2024; 144(9):4443-4453.

PMID: 39287787 PMC: 11564193. DOI: 10.1007/s00402-024-05547-4.

Intramedullary Total Femur via a Direct Anterior Approach for Complex Revision Total Hip and Knee Arthroplasty.

Taylor A, Gililland J, Anderson L Arthroplast Today. 2024; 28:101474.

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Periprosthetic fracture following anterior approach or dislocation after posterior approach: which one is the lesser evil?.

Verhaegen J, Schmidt-Braekling T, Wei R, Beaule P, Grammatopoulos G Arch Orthop Trauma Surg. 2023; 144(1):465-473.

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