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. 2024 Dec 18;145(1):69.
doi: 10.1007/s00402-024-05727-2.

A systematic review on revision total hip arthroplasty employing the direct anterior approach

Cord J Peters  1 , Erika Dopson  2 , Jeremy A Ross  3 , Ashton H Goldman  4
Affiliations

A systematic review on revision total hip arthroplasty employing the direct anterior approach

Cord J Peters et al. Arch Orthop Trauma Surg. .

Abstract

Introduction: The increased use of the direct anterior approach (DAA) for primary total hip arthroplasty (THA) has extended to revision THA. This systematic review evaluated studies reporting both the utility and clinical outcomes of revision THA using DAA, focusing on studies comparing revision approaches.

Materials and methods: A review of the Cochrane Library, EMBASE, and MEDLINE databases identified 577 publications. 538 were excluded after abstract screening. Full-text review identified 21 studies with 1627 patients. All studies were retrospective, level IV evidence. MINORS criteria rated 14 as poor and seven as moderate. Five studies compared DAA to alternative approaches. Meta-analysis was not performed due to significant heterogeneity and lack of comparative studies.

Results: The most common indications for revision were aseptic loosening (n = 929) and polyethylene wear (n = 158). The majority of the studies (n = 11/21) performed primarily acetabular revision or head-liner exchanges. Half the revisions (50.6%; n = 823/1627) included femoral revisions (35.2%; n = 573/1627) or combined femoral-acetabular revisions (15.4%; n = 250/1627). However, 80.6% (n = 462/573) of femoral revisions were from two non-comparative studies. Among the five comparative studies, two included femoral or combined revisions with significantly more performed using the posterior approach. Three of the five comparative studies did not find the DAA protective against postoperative dislocation. The overall complication rate was 14.0%; periprosthetic femoral fracture (n = 106), dislocation (n = 80), and infection (n = 36) were most common. Fourteen studies reported patient-reported outcome measures, demonstrating consistent improvements following revision THA.

Conclusions: Current data on revision DAA THA are limited due to their retrospective nature. They demonstrate the ability to safely perform acetabular and head-liner revisions in carefully selected patients. Comparative studies lack femoral revisions, show a propensity for femoral fractures, and exhibit selection bias. Higher-quality, comparative prospective studies are needed.

Trial registration: PROSPERO: CRD4202236457.

Keywords: Direct anterior approach; Outcomes; PROMs; Revision total hip arthroplasty; Systematic review.

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Conflict of interest statement

Declarations. Conflict of interest: Authors Cord Peters, Erika Dopson, and Ashton Goldman declare they have no financial interests. Jeremy Ross is a paid consultant with Depuy Synthes. IRB approval: The study protocol was approved by the Naval Medical Center Portsmouth Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects. Consent for publication: The views expressed in this article reflect the results of research conducted by the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government. I am a military service member. This work was prepared as part of my official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person’s official duties.

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