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

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.