A Comparison of Risk of Dislocation and Cause-Specific Revision Between Direct Anterior and Posterior Approach Following Elective Cementless Total Hip Arthroplasty

• Published in: The Journal of arthroplasty 2020-06, Vol.35 (6), p.1651-1657
• Main Authors: Charney, Mark, Paxton, Elizabeth W., Stradiotto, Ronald, Lee, John J., Hinman, Adrian D., Sheth, Dhiren S., Prentice, Heather A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antiviral Agents; Arthroplasty, Replacement, Hip - adverse effects; Cohort Studies; direct anterior approach; dislocation; Hepatitis C, Chronic; Hip Dislocation - epidemiology; Hip Dislocation - etiology; Hip Dislocation - surgery; Hip Prosthesis - adverse effects; Humans; posterior approach; Prosthesis Failure; Reoperation; Retrospective Studies; revision; Risk Factors; surgical approach; total hip arthroplasty; Treatment Outcome
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2020.01.033

Use of the direct anterior approach (DAA) for total hip arthroplasty (THA) has increased over the last decade. We sought to investigate whether (1) a difference exists in dislocation risk for DAA compared with posterior THA, (2) a difference exists in risk for specific revision reasons, and (3) the likelihood of adverse 90-day postoperative events differs. We conducted a cohort study using data from Kaiser Permanente’s Total Joint Replacement Registry. Patients aged ≥18 years who underwent primary cementless THA for osteoarthritis with a highly cross-linked polyethylene liner were included (2009-2017). Multivariable Cox proportional hazards regression was used to evaluate dislocation and cause-specific revision risks, and multivariable logistic regression was used to evaluate 90-day emergency department visits, 90-day unplanned readmissions, and 90-day complications (including deep infection, deep vein thrombosis, and pulmonary embolism). Of 38,399 primary THA, 6428 (16.7%) were DAA. All-cause revision at 2-years follow-up was 1.78% (95% confidence interval [CI] = 1.46-2.17) for DAA and 2.28% (95% CI = 2.11-2.45) for posterior. After adjusting for covariates, DAA had a lower risk of dislocation (hazard ratio [HR] = 0.39, 95% CI = 0.29-0.53), revision for instability (HR = 0.33, 95% CI = 0.18-0.58), revision for periprosthetic fracture (HR = 0.57, 95% CI = 0.34-0.96), and readmission (odds ratio = 0.82, 95% CI = 0.67-0.99) compared with posterior approach but a higher risk of revision for aseptic loosening (HR = 2.26, 95% CI = 1.35-3.79). While the DAA associated with lower risks of dislocation and revision for instability and periprosthetic fracture, it is associated with a higher revision risk for aseptic loosening. Surgeons should discuss these risks with their patients.