Anterior Revision Hip Arthroplasty is Associated With Higher Wound Complications but Fewer Dislocations Compared to Posterior Revision Hip Surgery

Kurkis, Gregory; Chihab, Samir; Farley, Kevin X.; Anastasio, Albert T.; Bradbury, Thomas L.; Guild, George N.

doi:10.1016/j.arth.2020.07.030

Cited by 9 publications

(5 citation statements)

References 13 publications

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“…The deep infection rate in our series was comparable with published infection rates after rTHA through different approaches, ranging from 1 to 8% [ 22 , 32 ]. In the setting of our study, we cannot extrapolate any conclusion about the superiority of the DAA to other approaches with respect to deep infection rates.…”

Section: Discussionsupporting

confidence: 88%

“…have found a decreased dislocation rate of two percent compared to 13% in the PA group ( P = 0.002) and a significantly increased risk of wound complications in the DAA cohort (7% vs. 0.5%), and the findings remain valid after multivariate regression analysis. In addition, a trend towards more overall 90-day complications was seen in the PA group (OR 1.71) [ 22 ]. We believe, by externally rotating and extending the hip, abductor muscle insertions on the greater trochanter are excluded from the surgical field.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, in the United States Medicare population, infection is shown to be the most common complication after revision surgeries, with a total rate of 17% in 3555 revised hips between 1998 and 2011 [33]. When comparing revisions through the DAA and the PA, literature revealed no difference in the deep infection rate [18,22]. Revision surgery is associated with longer operative time, an independent risk factor for surgical site infection and a high infection rate [34].…”

Section: Discussionmentioning

confidence: 99%

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A low dislocation rate after revision total hip arthroplasty performed through the anterior approach

et al. 2023

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Background Dislocation is a major complication in revision total hip arthroplasties. This study aimed to evaluate the dislocation rate, complications, and functional scores of revision total hip arthroplasty performed through the direct anterior approach. Methods Between January 2014 and March 2020, 84 patients undergoing revision total hip arthroplasty were retrospectively reviewed. All operations were performed through the direct anterior approach. At the final follow-up, incidences of dislocation, reoperation, acute deep infections, periprosthetic fractures and psoas impingement were assessed. The median postoperative Oxford Hip Score was also calculated. Results At revision surgery, the mean age was 66 ± 12 years (range, 28–91). During an average follow-up of 4.2 ± 1.2 years, reoperation rate for major complications in the non-infected revisions was 15% (n = 11), including five acute deep infections (7%), four periprosthetic fractures (5%), one dislocation and one psoas impingement (1%). The median postoperative Oxford Hip Score was 39 (interquartile range = 14). Conclusion In our series, revision total hip arthroplasty through direct anterior approach was associated with a very low dislocation rate, acceptable complication rates and good functional results. Our results suggest that this procedure is safe and reliable. Trial registration Ethical approval for this study was obtained, before enrollment of the first participant, by CUB Erasme's research ethics committee (P2020/323) and C.H.U Ambroise Paré's research ethics committee.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A low dislocation rate after revision total hip arthroplasty performed through the anterior approach

et al. 2023

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“…Due to the extensive exposure in revision arthroplasty, the soft tissue deconstruction process is more severe, especially in revision for PJI because of the thorough debridement procedure. In addition, the posterolateral approach is commonly applied in rTHA, which also leads to injuries of the abduction muscles and an increased risk of dislocation ( 56 , 57 ). Moreover, the rotation center may not restore in its original position and the offset may also be unsatisfying after rTHA.…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiological outcomes of jumbo cup in revision total hip arthroplasty: A systematic review

Wang

Liu

et al. 2022

Front. Surg.

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IntroductionMany studies have reported the clinical outcomes of a jumbo cup in revision total hip arthroplasty (rTHA) with acetabular bone defect. We conducted a systematic review to access the survivorship and clinical and radiological outcomes of a jumbo cup in rTHA.MethodsA systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search from PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was performed with the keywords (“revision” OR “revision surgery” OR “revision arthroplasty”) AND (“total hip arthroplasty” OR “total hip replacement” OR “THA” OR “THR”) AND (“jumbo cup” OR “jumbo component” OR “extra-large cup” OR “extra-large component”). Studies reporting the clinical or radiological outcomes were included. The basic information and radiological and clinical results of these studies were extracted and summarized for analysis.ResultsA total of 19 articles were included in the systematic review. The analysis of clinical results included 953 hips in 14 studies. The re-revision-free survivorship of the jumbo cup was 95.0% at a mean follow-up of 9.3 years. Dislocation, aseptic loosening, and periprosthetic joint infection were the top three complications with an incidence of 5.9%, 3.0%, and 2.1%, respectively. The postrevision hip center was relatively elevated 10.3 mm on average; the mean postoperative leg-length discrepancy was 5.4 mm.ConclusionA jumbo cup is a favorable option for acetabular bone defect reconstruction in rTHA with satisfying survivorship and acceptable complication rates.

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“…In spite of the above mentioned advantages, the DAA is not the panacea of surgical approaches to the hip, as it has been associated with a significant learning curve (23)(24)(25)(26) an increased risk of lateral femoral cutaneous nerve neuropraxias (15,27), higher rates of intra-operative femoral fractures (15,28), greater rates of early femoral revision (29,30) (LFCN and an increased risk of wound complications (31,32).…”

Section: Current Perspectives Of South African Orthopaedic Surgeons T...mentioning

confidence: 99%

Current perspectives of south african orthopaedic surgeons to the direct anterior approach in total hip arthroplasty

Pietrzak,

Geldenhuys,

Sikhauli

et al. 2024

E Af Orth Jnl

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Background: Despite the global increase in popularity for the use of the Direct Anterior Approach (DAA) for Total Hip Arthroplasty (THA), the current beliefs and reasons for its use and disuse amongst South African orthopaedic surgeons is not well understood. Objective: To determine the perspectives regarding DAA compared to other surgical approaches to THA. Methods: We conducted an anonymous online survey sent to all current members of the South African Orthopedic Association (SAOA). Results: The response rate was 24.25% (n=194). There were 76 (39.18%) respondents that have performed DAA (DAA Performers) and 118 (60.82%) that have never performed DAA (DAA nonperformers). A proportion of 50% and 11.84% of DAA performers were between 30 to 45 years and older than 60 years of age, respectively (p<0.000). The DAA is the preferred approach to THA for 36.84% (n=28) of DAA performers, whilst 63.16% (n=48) prefer an alternative approach. Both DAA performers who prefer DAA and those who prefer alternative approaches consider DAA more satisfactory for length of hospital stay (p<0.000) and short-term functional outcomes (p=0.002) compared to other surgical approaches. For DAA non-performers, the primary reasons for not performing DAA THA were inexperience in surgical technique (72.09%), increased operative time (12.79%), unsatisfactory outcomes (27.91%) and learning curve (67.44%). There were 5 (18.52%) and 30 (70.33%) surgeons who have been in clinical practice for more than 10 years that do and do not intend to use DAA in the future, respectively (p<0.000). Conclusion: The trends of the adoption of the DAA by South African orthopaedic surgeons show increasing popularity, similar to patterns seen in the United Kingdom and the United States of America. Younger surgeons are more likely to perform the DAA THA whilst more experienced surgeons are less likely to deviate from their current standard of practice.

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Anterior Revision Hip Arthroplasty is Associated With Higher Wound Complications but Fewer Dislocations Compared to Posterior Revision Hip Surgery

Cited by 9 publications

References 13 publications

A low dislocation rate after revision total hip arthroplasty performed through the anterior approach

A low dislocation rate after revision total hip arthroplasty performed through the anterior approach

Clinical and radiological outcomes of jumbo cup in revision total hip arthroplasty: A systematic review

Current perspectives of south african orthopaedic surgeons to the direct anterior approach in total hip arthroplasty

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