A Comparison of Risk of Dislocation and Cause-Specific Revision Between Direct Anterior and Posterior Approach Following Elective Cementless Total Hip Arthroplasty |
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| Institution: | 1. Department of Orthopaedic Surgery, The Permanente Medical Group, Vallejo, CA;2. Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA;3. Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Harbor City, CA;4. Department of Orthopaedic Surgery, The Permanente Medical Group, San Leandro, CA;5. Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Irvine, CA;1. Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire;2. Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire;1. Research Fellow, Department of Surgical Research, Anne Arundel Medical Center, Annapolis, Maryland;2. General Surgery Resident, Anne Arundel Medical Center, Annapolis, Maryland;3. Department of Surgical Research, Anne Arundel Medical Center, Annapolis, Maryland;4. Director, Center for Joint Replacement, Anne Arundel Medical Center, Annapolis, Maryland;1. Department of Orthopedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands;2. Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;3. Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands;4. Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten), ''s Hertogenbosch, The Netherlands;5. Department of Orthopedic Surgery, Isala Hospital, Zwolle, The Netherlands;6. Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands;1. Colorado Joint Replacement, Denver, CO;2. OrthoCarolina Hip & Knee Center, Charlotte, NC;3. OrthoCarolina Research Institute, Charlotte, NC |
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| Abstract: | BackgroundUse of the direct anterior approach (DAA) for total hip arthroplasty (THA) has increased over the last decade. We sought to investigate whether (1) a difference exists in dislocation risk for DAA compared with posterior THA, (2) a difference exists in risk for specific revision reasons, and (3) the likelihood of adverse 90-day postoperative events differs.MethodsWe conducted a cohort study using data from Kaiser Permanente’s Total Joint Replacement Registry. Patients aged ≥18 years who underwent primary cementless THA for osteoarthritis with a highly cross-linked polyethylene liner were included (2009-2017). Multivariable Cox proportional hazards regression was used to evaluate dislocation and cause-specific revision risks, and multivariable logistic regression was used to evaluate 90-day emergency department visits, 90-day unplanned readmissions, and 90-day complications (including deep infection, deep vein thrombosis, and pulmonary embolism).ResultsOf 38,399 primary THA, 6428 (16.7%) were DAA. All-cause revision at 2-years follow-up was 1.78% (95% confidence interval CI] = 1.46-2.17) for DAA and 2.28% (95% CI = 2.11-2.45) for posterior. After adjusting for covariates, DAA had a lower risk of dislocation (hazard ratio HR] = 0.39, 95% CI = 0.29-0.53), revision for instability (HR = 0.33, 95% CI = 0.18-0.58), revision for periprosthetic fracture (HR = 0.57, 95% CI = 0.34-0.96), and readmission (odds ratio = 0.82, 95% CI = 0.67-0.99) compared with posterior approach but a higher risk of revision for aseptic loosening (HR = 2.26, 95% CI = 1.35-3.79).ConclusionWhile the DAA associated with lower risks of dislocation and revision for instability and periprosthetic fracture, it is associated with a higher revision risk for aseptic loosening. Surgeons should discuss these risks with their patients. |
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| Keywords: | total hip arthroplasty surgical approach direct anterior approach posterior approach dislocation revision |
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