Managing Complications of Total Hip Arthroplasty for Avascular Necrosis Hip Performed Via Anterior Approach

Early complications following direct anterior approach (DAA) total hip arthroplasty (THA) in avascular necrosis (AVN) pose challenges due to altered bone quality and anatomical variations. This study evaluates early complications, functional outcomes, and management strategies in 250 DAA THA cases at a resource-limited center.

A retrospective analysis was conducted on patients (18-65 years) who underwent DAA THA for AVN between January 2022 and December 2023. Exclusion criteria included prior hip surgeries, congenital deformities, and significant comorbidities. The surgical protocol focused on minimal tissue disruption and precise implant placement, aided by intraoperative fluoroscopy. Data on demographics, surgical details, complications, and functional outcomes (Harris hip score [HHS] and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) were collected at 2- and 6 weeks, and 1 year postoperatively.

The cohort included 197 males (78.8%) and 53 females (21.2%), with a mean age of 41.1 ± 14.4 years. The mean surgical time (incision to closure) was 73.7 ± 20.7 min/hip. Early complications occurred in 5.6% of cases: dislocation (0.4%), superficial infections (1.2%), lateral femoral cutaneous nerve injuries (3.2%), and limb length discrepancies (0.8%), all of which were successfully managed. Functional outcomes improved significantly, with HHS increasing from baseline 39.98 to 96.8 and WOMAC scores decreasing from baseline 58.9 to 9.2 in 1 year.

DAA THA is a safe and effective procedure for AVN, with low complications and significant functional improvement. Surgeon experience, meticulous technique, and standardized protocols optimize outcomes, supporting its viability in resource-constrained settings, though further research is needed.