Acetabular Total Hip Arthroplasty Revision: A Summary of Operative Factors,Outcomes, and Comparison of Approaches |
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| Institution: | 1. Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland;2. Campbell University School of Osteopathic Medicine, Lillington, North Carolina;1. Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania;2. Department of Orthopaedics & Sports Medicine, Maine Medical Partners, South Portland, Maine;3. OrthoCarolina, Charlotte, North Carolina;4. American Association of Hip and Knee Surgeons, Chicago, Illinois;1. Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand;2. Waitematā Pain Services, Te Whatu Ora Waitematā, Auckland, New Zealand;3. Department of Anaesthesiology and Perioperative Medicine, Te Whatu Ora Waitematā, Auckland, New Zealand;4. Department of Anaesthesiology, Faculty of Medicine and Health Sciences, University of Auckland, New Zealand;5. Discipline of Pharmacology, School of Biomedicine, University of Adelaide, Australia;6. Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, Australia;1. Health and Rehabilitation Sciences, Graduate Program, Faculty of Health Sciences, Western University, London, Ontario, Canada;2. Health and Rehabilitation Sciences, Adjunct Professor, Faculty of Health Sciences, Western University, London, Ontario, Canada;3. School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada;4. Division of Orthopaedic Surgery, Department of Surgery, University Hospital, London Health Sciences Centre, London, Ontario, Canada;1. Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana;2. Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia |
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| Abstract: | BackgroundRevision total hip arthroplasty (THA) presents a greater risk to patients than primary THA, and surgical approach may impact outcomes. This study aimed to summarize acetabular revisions at our institution and to compare outcomes between direct anterior and posterior revision THA.MethodsA series of 379 acetabular revision THAs performed from January 2010 through August 2022 was retrospectively reviewed. Preoperative, perioperative, and postoperative factors were summarized for all revisions and compared between direct anterior and posterior revision THA.ResultsThe average time to acetabular revision THA was 10 years (range, 0.04 to 44.1), with mechanical failure (36.7%) and metallosis (25.6%) being the most prevalent reasons for revision. No differences in age, body mass index, or sex were noted between groups. Anterior revision patients had a significantly shorter length of stay (2.2 versus 3.2 days, P = .003) and rate of discharge to a skilled nursing facility (7.5 versus 25.2%, P = .008). In the 90-day postoperative period, 9.2% of patients returned to the emergency department (n = 35) and twelve patients (3.2%) experienced a dislocation. There were 13.2% (n = 50) of patients having a rerevision during the follow-up period with a significant difference between anterior and posterior approaches (3.8 versus 14.7%, respectively, P = .049).ConclusionThis study provides some evidence that the anterior approach may be protective against skilled nursing facility discharge and rerevision and contributes to decreased lengths of stay. We recommend surgeons select the surgical approach for revision THA based on clinical preferences and patient factors. |
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| Keywords: | total hip arthroplasty revision total hip arthroplasty acetabular revision direct anterior approach posterior approach |
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