Postoperative acetabular component position in revision hip arthroplasty: a comparison of the anterior and posterior approaches

Abstract

Background: While previously considered unsuitable for revision total hip arthroplasty (rTHA), the direct anterior approach (DAA) can be extended to allow for safe acetabular component revision. In primary hip arthroplasty, the DAA and its associated fluoroscopy, has been shown to produce more acceptable component positioning. However, there is little data comparing the DAA to the posterior approach (PA) for rTHA. We hypothesised that, the DAA with intraoperative fluoroscopy would allow for more precise acetabular component positioning when compared to those performed using a PA. Methods: 50 consecutive patients (25 DAA and 25 PA) undergoing rTHA were included. Radiographic analysis of postoperative acetabular component position was then performed. Univariate and multivariate analyses was performed to assess the contribution of approach on cup positioning inside classically defined “safe zones”. Results: Baseline patient characteristics were similar. The PA was associated with more cups placed outside the Lewinnek (48% vs. 12%, p = 0.005) and the Danoff (52% vs. 28%, p = 0.083) “safe zones” when compared to the DAA. Multivariate analysis revealed that operative approach was the only patient or surgical factor associated with component position outside of the “safe zones” (Lewinnek [OR = 13.6; 95% CI, 2.12–87.9, p = 0.006] and Danoff [OR = 7.7; 95% CI, 1.48–40.1, p = 0.015]). Conclusion: Our results suggest that the DAA allows for more reproducible and precise cup placement in RTHA. The safe-zone paradigm remains a useful index of accurate cup positioning and the DAA, with use of intraoperative fluoroscopy, offers more consistent acetabular component positioning when compared to the PA.

Preoperative Ultrasound to Map the Three-Dimensional Anatomical Distribution of the Lateral Femoral Cutaneous Nerve in Direct Anterior Approach for Total Hip Arthroplasty

“…As a mini-invasion approach, DAA for THA is increasingly popular in the clinic because of soft tissue preservation using the inter-muscular and nervous plane,allowing for more reproducible and precise cup placement in supine posion, and fast functional discovery after surgery [9,22]. However, the abnormal sensation caused by LFCN injury on the area of anterolateral thigh, including numbness, paresthesia, and pain, is the most common complaint of patients after surgery [14,23].…”

“…This preference could be attributed to the reasons that DAA is a minimal soft invasion approach and uncovers the joint capsule through intermuscular and inter-nervous plane [3,4]. Compared to other approaches, such as direct lateral, anterolateral and posterior approach, patients after DAA THA had improved early ambulation capacity, fewer reoperations, enhanced functional recovery and a low dislocation rate [5][6][7][8][9]. However, a patient's anxiety is due to lateral femoral cutaneous nerve (LFCN) injury that results in hypesthesia, dysesthesia or pain in the anterolateral aspect of the thigh [10][11][12].…”

Intraoperative Radiographic Detection of Intrapelvic Acetabular Screw Penetration: Lessons Learned From Our Trauma Colleagues

“…Intraobserver and interobserver reliabilities were then calculated. In rare cases of surgeon disagreement, the surgeons undertook post hoc review of the discrepant image together and came to a consensus conclusion, per precedence [ 24 ]. Sensitivities, specificities, negative predictive value, and positive predictive values were then calculated.…”

“…In recent years, the direct anterior approach, and its associated use of fluoroscopy, has been popularized [ 22 ]. Fluoroscopy is useful in evaluating component position [ 23 , 24 ] and may also be useful in assessing trajectory of transacetabular screws. However, the effectiveness of intraoperative fluoroscopy to determine acetabular screw position has not been assessed.…”

Preoperative Ultrasound to Map the Three-dimensional Anatomical Distribution of the Lateral Femoral Cutaneous Nerve in Direct Anterior Approach for Total Hip Arthroplasty

“…This preference could be attributed to the reasons that DAA is a minimal soft invasion approach and uncovers the joint capsule through intermuscular and inter-nervous plane [3,4]. Compared to other approaches, such as direct lateral, anterolateral and posterior approach, patients after DAA THA had improved early ambulation capacity, fewer reoperations, enhanced functional recovery and a low dislocation rate [5][6][7][8][9]. However, a patient's anxiety is due to lateral femoral cutaneous nerve (LFCN) injury that results in hypesthesia, dysesthesia or pain in the anterolateral aspect of the thigh [10][11][12].…”