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. 2021 Jan 18;10(2):337.
doi: 10.3390/jcm10020337.

Femoral Revision Total Hip Arthroplasty Performed through the Interval of the Direct Anterior Approach

Martin Thaler  1 , Dietmar Dammerer  1 , Michael Ban  1 , Hermann Leitner  2 , Ismail Khosravi  1 , Michael Nogler  3
Affiliations

Femoral Revision Total Hip Arthroplasty Performed through the Interval of the Direct Anterior Approach

Martin Thaler et al. J Clin Med. .

Abstract

Background: we report the clinical outcomes for femoral revision total hip replacement (THR) using the Direct Anterior Approach (DAA) interval.

Methods: 149 patients (165 hips) with a mean age of 68.9 years (range, 33.2-91.0 years) and a mean follow-up of 4.2 years (1.1-8.9 years) were included. The indication for revision surgery was aseptic stem loosening in 131 (79.4%) hips, periprosthetic fracture in 29 (17.6%) hips, revision for stem malalignment in one (0.6%) hip, and prosthetic failure in four (2.4%) hips.

Results: an endofemoral approach was used for 156 hips, and a Wagner transfemoral osteotomy was used for nine hips. An additional cup revision was done in 52 hips (uncemented cup: n = 29; cemented cup: n = 21; acetabular cage: n = 2). The overall complication rate was 14.5% (24 complications). Ten patients (10 hips) were revised (8 cups, 2 liners, 2 stems) with an average time to revision of 6 months (range, 3-23 months). The median preoperative Western Ontario McMasters Osteoarthritis Score (WOMAC) score was 52.5 (Inter Quartile Range (IQR): 33.3), which improved to 27.2 (IQR: 30) postoperatively (p < 0.01).

Conclusion: use of the DAA achieved similar results when compared with other surgical approaches in terms of clinical outcomes and complications, including dislocation rate. These results suggest that femoral revision using the DAA interval can be a safe and reliable procedure.

Keywords: direct anterior approach; femoral revision; hip revision; total hip arthroplasty; total hip replacement.

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Conflict of interest statement

Martin Thaler is a consultant for Stryker. Dietmar Dammerer declares no conflict of interest. Michael Ban declares no conflict of interest. Leitner declares no conflict of interest. Ismail Khosravi declares no conflict of interest. Michael Nogler is a consultant for DJO and Stryker.

Figures

Figure 1
Figure 1
Intraoperative photograph showing straight access to the femur after tensor fascia latae (TFL) release using the Direct Anterior Approach (DAA) interval.
Figure 2
Figure 2
Western Ontario McMasters Osteoarthritis Score (WOMAC) scores showed a significant improvement (p < 0.05) postoperatively compared with preoperative scores at a mean follow-up of 4.2 years (range, 1.1–8.9 years). The median preoperative WOMAC score was 52.5 (IQR: 33.3), and the median postoperative WOMAC score was 27.2 (IQR: 30). IQR: Inter Quartile Range.
Figure 3
Figure 3
A radiograph showing a patient with a periprosthetic fracture (A), and the same patient after being treated with a modular stem (B). The implantation of the long modular stem and the reduction of the fracture was performed with a proximal and distal extension of the DAA.
Figure 4
Figure 4
A radiograph showing a patient with aseptic loosening of a femoral stem in the right hip (A,B). The implantation of the long revision stem was performed with a proximal extension of the DAA (C).
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