Lower risk of postoperative complications with Hardinge approach in revision total hip replacement surgery

The increasing volume of total hip replacement (THR), coupled with longer life expectancy and greater patient demands, is expected to result in a corresponding increase in revision THR. The surgical approach used for revision THR may influence postoperative outcomes, particularly the risk of dislocation. This study aimed to compare clinical outcomes following revision THR performed through the lateral and posterior approaches, with particular emphasis on postoperative dislocation rates.

We retrospectively reviewed prospectively collected registry data from 137 patients who underwent revision THR. Of these, 81 underwent revision THR through a lateral approach and 56 through a posterior approach. Propensity scores were generated using logistic regression to adjust for potential confounders, including age, sex, body mass index, and preoperative patient-reported outcome measures (Oxford Hip Score, WOMAC Pain, Stiffness and Physical Function scores, and SF-36 Physical and Mental Component Scores). Postoperative outcomes, including dislocation, blood loss, patient-reported outcome measures, and satisfaction, were compared between groups.

After propensity score matching, the incidence of dislocation was significantly higher in the posterior approach group than in the lateral approach group (16.1% vs. 1.8%, p = 0.02). The lateral approach was also associated with significantly lower postoperative blood loss compared with the posterior approach (change in haemoglobin: 1.5 vs. 2.5 g/dL, p < 0.001). No significant differences were observed between groups in SF-36, WOMAC, or Oxford Hip Scores at 6 months or 2 years postoperatively. However, patient satisfaction was significantly higher following the lateral approach at both 6 months (87.5% vs. 73.2% satisfied or very satisfied, p = 0.02) and 2 years (87.5% vs. 67.9%, p = 0.019).

In this cohort, revision THR performed through a lateral approach was associated with a significantly lower dislocation rate, lower blood loss, and higher patient satisfaction compared with the posterior approach, without significant differences in functional or health-related quality-of-life outcomes. The lateral approach appears to be a viable option for revision THR, particularly when minimising postoperative instability is a priority. Further comparative studies are warranted to validate these findings and determine the influence of surgical approach on outcomes following revision THR.