Does Surgical Approach Impact Wound Complication Rates after Revision Total Hip Arthroplasty?

While some literature suggests that wound complications are increased for primary total hip arthroplasty (THA) procedures utilizing the direct anterior (DA) approach, the impact of the surgical approach on wound complications after revision THA cases remains unknown. This study aimed to compare wound complications between different surgical approaches in revision THA.

The retrospective study identified 1,749 consecutive patients who underwent revision THA at a single institution between 2017 and 2023. Patients were categorized based on components revised (acetabular only, femur only, both-component, head-liner exchange) during revision THA and by surgical approach (DA, direct lateral (DL), postero-lateral (PL)) for each category. The primary outcome of the study was wound complications within 90 days of surgery.

The wound complication rates for acetabular-only revisions were 0.83 for DA approach, 4.64 for DL approach, and 3.9% for PL approach (P = 0.149). Femoral component revisions had wound complication rates of 9.68 for DA approach, 5.06 for DL approach, and 13.2% for PL approach (P = 0.065). For both component revisions, the wound complication rates were 5.83 for DA approach, 4.49 for DL approach, and 8.47% for PL approach (P = 0.28). Also, head and liner exchange wound complication rates were 6.94 for DA approach, 6.21 for DL approach, and 11.3% for PL approach (P = 0.301). Readmission rates and reoperation rates were similar for all approaches in all revisions except for femoral component revisions performed through the PL approach, which had an increased risk of readmission (12.3%, P = 0.008) and reoperation (10.4%, P = 0.012) compared to DA approach (8.6 and 6.45%, respectively) and DL approach (2.53 and 1.9%, respectively).

The surgical approach appears to have minimal impact on the likelihood of developing wound complications in revision THAs. The need for readmission and reoperation was also similar across surgical approaches for various revision THA procedures.