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Instability Following Head and Liner Exchange: Eight-Fold Reduction in Dislocation With the Direct Anterior Approach.

Elizabeth B Gausden1, Sina Afzal1, Pravjit Bhatti1

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|April 22, 2026
PubMed
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The direct anterior approach (DAA) significantly reduces dislocation risk following hip replacement head and liner exchange (HLE) compared to the postero-lateral approach (PLA). This study found DAA associated with a nearly eight-fold lower risk of dislocation, improving patient outcomes.

Keywords:
direct anterior approachdislocationhead and liner exchangehip dislocationposterolateral approach

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Area of Science:

  • Orthopedic Surgery
  • Arthroplasty Research
  • Biomechanics

Background:

  • Isolated head and liner exchange (HLE) is a less invasive option for specific revision total hip arthroplasty (THA) cases.
  • Dislocation remains the most common complication following HLE procedures.

Purpose of the Study:

  • To compare the dislocation incidence between the direct anterior approach (DAA) and the postero-lateral approach (PLA) for isolated HLE.
  • To evaluate the impact of surgical approach on revision THA outcomes.

Main Methods:

  • Retrospective review of 176 isolated HLE cases (129 PLA, 47 DAA) between 2016-2025, excluding those with prior infection or instability.
  • Cox proportional hazards regressions used to compare dislocation and reoperation survival between DAA and PLA groups.
  • Analysis of implant variations including femoral head diameter, elevated liners, dual mobility constructs, and constrained liners.

Main Results:

  • One-year dislocation incidence was significantly lower with DAA (2.4%) compared to PLA (12.4%) (P=0.02).
  • Dislocation-free survivorship was higher for DAA (Hazard Ratio for PLA vs. DAA: 7.68, P=0.04).
  • One-year reoperation incidence was 2.7% for DAA versus 6.2% for PLA, with no significant difference in reoperation-free survivorship (P=0.20).

Conclusions:

  • The direct anterior approach (DAA) for isolated HLE is associated with a substantially lower risk of dislocation compared to the postero-lateral approach (PLA).
  • This reduced dislocation risk with DAA was observed despite less frequent use of dislocation-mitigating implants.
  • Surgeons may consider DAA for isolated HLE to potentially decrease postoperative instability and improve patient outcomes.