Evaluation of Direct Anterior Approach for Revision Total Hip Arthroplasty: A Systematic Review

Abstract

The direct anterior approach (DAA) is an established approach for total hip arthroplasty (THA) but has been sparingly tried for revisions. The purpose of this study was to examine the available literature in order to consolidate information available on revision THA using the DAA. A PubMed, Embase, and Scopus search was performed using relevant keywords. Studies reporting on patients undergoing revision THA using DAA were included for analysis. In a review of the literature, nine studies matched the pre-decided inclusion criteria with 319 hip joints undergoing revision THA. Mean follow-up of all included studies was 34 months. The indications of revision after primary THA in decreasing order were aseptic loosening (53%), prosthetic joint infection (20.7%), peri-prosthetic fracture (16.9%), dislocation (7.2%), psoas impingement (1.9%), polyethylene wear (1.2%), pain (0.6%), and instability (0.3%). Of the 319 revisions evaluated, 107 underwent a stem revision, 142 underwent cup revision, 49 underwent a combined revision, and 21 underwent isolated liner/head change. A statistically significant improvement in functional score ( P <0.05) was observed for all studies reporting on functional outcomes. A low complication rate (51/319, 16.0%), which includes dislocation (12), infection (12), loosening of the acetabular shell (5), peri-prosthetic fractures (6), haematoma (4), and transient nerve palsy (6), was reported. Based on available level III-IV evidence, DAA appears to be a reliable alternative for revision of the failed hip arthroplasty with acceptable complication rates. Evidence of a higher quality is needed to further characterize its role in revision scenarios.

Comparing dislocation rates by approach following elective primary dual mobility total hip arthroplasty: a systematic review

“…While several other systematic reviews and meta-analyses have analyzed surgical approaches in THA, the present review is the first to specifically investigate whether surgical approach in THA using dual mobility constructs affect clinical outcomes in patients undergoing primary THA. As in our current study, previous reviews have found that postoperative complications and dislocation rates are generally low following THA in non-high-risk populations, and that utilizing the DAA, ALA, DLA, or PLA may result in similar long-term outcomes [ 6 , 94 – 97 ]. For example, a 2017 systematic review of 42 studies found that functional hip outcomes (e.g., HHS) were significantly improved for DAA in the short-term (6 weeks postoperatively), but differences were not generally sustained past that point [ 6 ].…”

Revision Total Hip Arthroplasty using a Direct Anterior Approach in a Patient with Arthrogryposis Multiplex Congenita: A Case Report

“…Multiple studies have reported that DAA for can be successfully used for rTHA. A systematic review by Singh et al reported on 319 rTHAs performed via the DAA across 9 studies, with 158 hips undergoing rTHA for aseptic loosening of the acetabular cup (Singh, Khurana, and Gupta 2021). They found that across the studies, most patients had a good or excellent outcome after rTHA and the overall complication rate was 1.6% (Singh, Khurana, and Gupta 2021).…”

“…A systematic review by Singh et al reported on 319 rTHAs performed via the DAA across 9 studies, with 158 hips undergoing rTHA for aseptic loosening of the acetabular cup (Singh, Khurana, and Gupta 2021). They found that across the studies, most patients had a good or excellent outcome after rTHA and the overall complication rate was 1.6% (Singh, Khurana, and Gupta 2021). Kurkis et al reported on 99 successful DAA rTHAs and showed that the DAA rTHA was associated with a lower risk of dislocations, but a higher risk of superficial wound complications (Kurkis et al 2021).…”