Changing surgical approach from primary to revision THA does not affect outcomes
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Compared with concordant approaches, discordant surgical approaches between primary and revision total hip arthroplasty have no impact on dislocation, re-revision, reoperation or complication rates, according to published results.
Joshua R. Harmer, MD, and colleagues at Mayo Clinic, Rochester retrospectively analyzed data on 705 patients (mean age of 65 years) who underwent both primary and revision THA at the same academic center between 2000 and 2018 with at least 2 years of follow-up.
In primary cases, 49% of THAs (n = 345) were performed with a posterior approach, 47% (n = 331) were performed with a laterally based approach and 4% (n = 29) were performed with a direct anterior approach. In revision cases, 52% of THAs (n = 364) were performed with a posterior approach, 47% (n = 333) were performed with a laterally based approach and 1% (n = 8) were performed with a direct anterior approach. This resulted in 97 cases (14%) of discordance between approaches, which was most frequent when the direct anterior approach was used for primary THA. According to the study, discordance was also more frequent when the index and revision THAs were performed by different surgeons.
Harmer and colleagues found no significant differences in 5-year cumulative dislocation rates, re-revision rates, reoperation rates and nonoperative complication rates for the overall cohort or when analyzed by primary approach. The 5-year cumulative dislocation rate was 14% in patients with concordant surgical approaches and 8% in patients with discordant surgical approaches. While not a statistically significant difference, this finding was surprising, the researchers noted.
At 5 years, the overall cumulative re-revision rate was 15.6%; the overall cumulative reoperation rate was 19%; and the overall cumulative nonoperative complication rate was 18%.
“There is theoretical concern that performing surgery through multiple planes could potentiate dislocation risk,” the researchers wrote in the study. “These data provide reassurance that changing [vs.] maintaining the surgical approach from primary to revision THA does not significantly increase dislocation risk or that of re-revision, reoperations and nonoperative complications. Surgical approach in revision THA should be dictated by surgeon preference and experience,” they concluded.
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