Direct anterior THA linked with lowered risk of dislocation, revision
Compared with the posterior approach to total hip arthroplasty, the direct anterior approach lowered the risk of dislocation and revision, according to published results.
Using their institutional database, Jacob A. Haynes, MD, and colleagues at the Anderson Orthopaedic Research Institute in Alexandria, Virginia analyzed 5,065 THAs done with the direct anterior approach (DAA) and 3,775 THAs done with the posterior approach (PA). Outcome measures included survivorship, with dislocation as the endpoint, and revision. Mean follow-up was 1.7 years in the DAA cohort and 3.1 years in the PA cohort.
Overall, 3.3% of hips in the PA cohort had a dislocation vs. 0.5% of hips in the DAA cohort. Five-year Kaplan-Meier survivorship with dislocation as an endpoint was 95.4% in the PA cohort and 99.1% in the DAA cohort. Additionally, Haynes and colleagues found dislocation risk was 4.9 times higher in the PA cohort compared with the DAA cohort. Revision incidence was 1.1% in the PA cohort and 0.2% in the DAA cohort.
“Regardless of approach, most dislocations occurred in the posterior direction during activities of daily living,” Haynes and colleagues wrote in the study. “Owing to the morbidity of dislocation following THA, we recommend consideration of the various strategies to decrease the incidence of postoperative instability, including surgical approach, larger femoral head diameter and intraoperative technologies to aid in component positioning,” they added.
Editor's Note: This article was revised on Jan. 14, 2022 to more accurately reflect dislocation as an endpoint for survivorship.
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