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Surgical Approach Does Not Influence Instability Risk in Revision Total Hip Arthroplasty
Eric S Secrist1, Kelly Boutelle2, Devon R Pekas1
1Department of Orthopaedic Surgery, Carilion Clinic Institute for Orthopaedics & Neurosciences, Roanoke, Virginia.
The Journal of Arthroplasty
|June 13, 2024
Summary
Direct anterior (DA) and postero-lateral (PL) approaches show similar dislocation rates for revision total hip arthroplasty (THA). Surgeon experience and patient needs should guide approach selection for revision THA.
Area of Science:
- Orthopedic Surgery
- Arthroplasty
- Hip Reconstruction
Background:
- Direct anterior (DA) approach popularity for primary total hip arthroplasty (THA) contrasts with limited evidence for revision THA.
- The dislocation benefit of the DA approach in primary THA is not well-established for revision cases.
Purpose of the Study:
- To compare dislocation rates between DA and postero-lateral (PL) approaches in revision THA.
- To evaluate the influence of primary surgical approach on revision THA outcomes.
Main Methods:
- Retrospective review of revision THA cases (2011-2021) comparing DA and PL approaches.
- Exclusion of cases with instability, multiple prior revisions, non-DA/PL approaches, or specialized implants.
- 182 hips in 173 patients analyzed with an average follow-up of 6.5 years.
Main Results:
- No significant difference in dislocation rates between DA (8.1%) and PL (7.5%) revision THA cohorts (P=.999).
- A trend towards lower dislocation with discordant primary/revision approaches (4.9% vs. 8.5%) was not statistically significant (P=.740).
- Shorter length of stay observed for DA revisions following primary PL procedures (P=.021).
Conclusions:
- Dislocation rates for revision THA are comparable between DA and PL approaches.
- Approach choice for revision THA should be individualized based on surgeon expertise and patient factors.
