The Direct Anterior Approach is Associated with Early Revision Total Hip Arthroplasty

• Published in: The Journal of arthroplasty 2017-03, Vol.32 (3), p.1001-1005
• Main Authors: Eto, Shuichi, M.D., Ph.D, Hwang, Katherine, M.S, Huddleston, James I., M.D, Amanatullah, Derek F., M.D., Ph.D, Maloney, William J., M.D, Goodman, Stuart B., M.D., Ph.D
• Format: Article
• Language: English
• Subjects: Aged; anterolateral approach; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - methods; direct anterior approach; Female; hip arthroplasty; Hip Prosthesis; Humans; Male; Middle Aged; Orthopedics; posterior approach; Prosthesis Failure - etiology; Referral and Consultation; Reoperation - statistics & numerical data; Retrospective Studies; revision; surgical approach
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2016.09.012

Background The direct anterior approach for THA has generated increased interest recently. The purpose of this study was to compare the duration to failure and reasons for revision of primary THA performed elsewhere and subsequently revised at our institution after the direct anterior versus other non-anterior surgical approaches to the hip. Methods All primary THAs performed elsewhere and referred to our institution for revision were divided into direct anterior approach (30 cases) or non-anterior approach groups (100 cases, randomly selected from 453 cases) based on the original surgical approach. Because all primary direct anterior THAs were originally performed after 2004, to eliminate temporal bias, we identified a subset of the non-anterior group in which the primary THA was performed after 2004 (known as recent non-anterior group, 100 cases, randomly selected from 169 available cases). Results The mean duration from primary to revision THA was 3.0 ± 2.7 years (direct anterior approach), 12.0 ± 8.8 years (non-anterior approach), and 3.6 ± 2.8 years (recent non-anterior), respectively. There was a significant difference in time to revision between the direct anterior and non-anterior approach groups (p < 0.001). Aseptic loosening of the stem was significantly more frequent with the direct anterior approach group (9/30, 30.0%) when compared to the non-anterior group (8/100, 8.0%, p = 0.007) and the recent non-anterior group (7/100, 7.0%, p = 0.002). Conclusion Revision of the femoral component for aseptic loosening is more commonly associated with the direct anterior approach in our referral practice.