Abstract
Despite increasing numbers of primary hip arthroplasties performed through the direct anterior approach (DAA), there is a lack of literature on DAA revision arthroplasty. The present study was performed in order to evaluate outcomes and revision rates after revision through the DAA using an asymmetric acetabular component with optional intra- and extramedullary fixation. In a retrospective cohort study, we analyzed prospectively collected data of 57 patients (61 hips, 43 female, 18 male) who underwent aseptic acetabular component revision through the DAA with the abovementioned implant system between January 2015 and December 2017. The mean follow-up was 40 months (12–56). Survival rates were estimated using the Kaplan–Meier method. All complications were documented and functional outcomes were assessed pre- and postoperatively. Kaplan–Meier analysis revealed an estimated five-year implant survival of 97% (confidence interval CI 87–99%). The estimated five-year survival with revision for any cause was 93% (CI 83–98%). The overall revision rate was 6.6% (n = 4). Two patients had to undergo revision due to periprosthetic infection (3.3%). In one patient, the acetabular component was revised due to aseptic loosening four months postoperatively. Another patient suffered from postoperative iliopsoas impingement and was treated successfully by arthroscopic iliopsoas tenotomy. Two (3.3%) of the revised hips dislocated postoperatively. The mean Harris Hip Score improved from 35 (2–66) preoperatively to 86 (38–100) postoperatively (p < 0.001). The hip joint’s anatomical center of rotation was restored at a high degree of accuracy. Our findings demonstrate that acetabular revision arthroplasty through the DAA using an asymmetric acetabular component with optional intra- and extramedullary fixation is safe and practicable, resulting in good radiographic and clinical midterm results.
Highlights
In the direct anterior approach (DAA), the surgeon enters the hip joint through the intermuscular and interneural plane between the tensor fasciae latae (TFL) and the sartorius muscle [1]
Despite increasing numbers of primary hip arthroplasties performed through the direct anterior approach (DAA), there is a lack of literature on DAA revision arthroplasty
Our findings demonstrate that acetabular revision arthroplasty through the DAA using an asymmetric acetabular component with optional intra- and extramedullary fixation is safe and practicable, resulting in good radiographic and clinical midterm results
Summary
In the direct anterior approach (DAA), the surgeon enters the hip joint through the intermuscular and interneural plane between the tensor fasciae latae (TFL) and the sartorius muscle [1]. Due to the supine positioning of DAA patients, intraoperative leg length evaluation and fluoroscopic control of implant positioning may be facilitated. An American Association of Hip and Knee Surgeons (AAHKS) survey documented an increasing use of the DAA among respondents, from 12% in 2010 to 40% in 2018 [6]. Parallel to the increasing number of hip procedures performed via the DAA, the number of patients with clinical problems after DAA hip arthroplasty will inevitably increase [6] Hip surgeons and their patients have to be aware of the disadvantages associated with the use of the DAA, such as a steep learning curve and a putatively higher infection rate when compared to other approaches [8,9,10]. The purpose of the following study was to analyze the clinical and radiographic outcome of patients who underwent aseptic acetabular component revision through the DAA using an asymmetric acetabular component with optional extra- and intramedullary iliac fixation
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