Revision Arthroplasty Through the Direct Anterior Approach Using an Asymmetric Acetabular Component
Despite increasing numbers of primary hip arthroplasties performed through the direct anterior approach (DAA), there is a lack of literature on DAA revision arthroplasty. The present study was performed in order to evaluate outcomes and revision rates after revision through the DAA using an asymmetr...
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doaj-927db1b15ab843b584c08510e37dfaec2020-11-25T02:52:01ZengMDPI AGJournal of Clinical Medicine2077-03832020-09-0193031303110.3390/jcm9093031Revision Arthroplasty Through the Direct Anterior Approach Using an Asymmetric Acetabular ComponentPeter Michael Prodinger0Igor Lazic1Konstantin Horas2Rainer Burgkart3Rüdiger von Eisenhart-Rothe4Manuel Weissenberger5Maximilian Rudert6Boris Michael Holzapfel7Department of Orthopaedic Surgery, Krankenhaus Agatharied, Norbert-Kerkel-Platz, 83734 Hausham, GermanyDepartment of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, GermanyDepartment of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, GermanyDepartment of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, GermanyDepartment of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, GermanyDepartment of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, GermanyDepartment of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, GermanyDepartment of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, GermanyDespite increasing numbers of primary hip arthroplasties performed through the direct anterior approach (DAA), there is a lack of literature on DAA revision arthroplasty. The present study was performed in order to evaluate outcomes and revision rates after revision through the DAA using an asymmetric acetabular component with optional intra- and extramedullary fixation. In a retrospective cohort study, we analyzed prospectively collected data of 57 patients (61 hips, 43 female, 18 male) who underwent aseptic acetabular component revision through the DAA with the abovementioned implant system between January 2015 and December 2017. The mean follow-up was 40 months (12–56). Survival rates were estimated using the Kaplan–Meier method. All complications were documented and functional outcomes were assessed pre- and postoperatively. Kaplan–Meier analysis revealed an estimated five-year implant survival of 97% (confidence interval CI 87–99%). The estimated five-year survival with revision for any cause was 93% (CI 83–98%). The overall revision rate was 6.6% (n = 4). Two patients had to undergo revision due to periprosthetic infection (3.3%). In one patient, the acetabular component was revised due to aseptic loosening four months postoperatively. Another patient suffered from postoperative iliopsoas impingement and was treated successfully by arthroscopic iliopsoas tenotomy. Two (3.3%) of the revised hips dislocated postoperatively. The mean Harris Hip Score improved from 35 (2–66) preoperatively to 86 (38–100) postoperatively (<i>p</i> < 0.001). The hip joint’s anatomical center of rotation was restored at a high degree of accuracy. Our findings demonstrate that acetabular revision arthroplasty through the DAA using an asymmetric acetabular component with optional intra- and extramedullary fixation is safe and practicable, resulting in good radiographic and clinical midterm results.https://www.mdpi.com/2077-0383/9/9/3031anterior approachrevision arthroplastyhip jointacetabular bone defectasymmetric implantanatomic center of rotation |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Peter Michael Prodinger Igor Lazic Konstantin Horas Rainer Burgkart Rüdiger von Eisenhart-Rothe Manuel Weissenberger Maximilian Rudert Boris Michael Holzapfel |
spellingShingle |
Peter Michael Prodinger Igor Lazic Konstantin Horas Rainer Burgkart Rüdiger von Eisenhart-Rothe Manuel Weissenberger Maximilian Rudert Boris Michael Holzapfel Revision Arthroplasty Through the Direct Anterior Approach Using an Asymmetric Acetabular Component Journal of Clinical Medicine anterior approach revision arthroplasty hip joint acetabular bone defect asymmetric implant anatomic center of rotation |
author_facet |
Peter Michael Prodinger Igor Lazic Konstantin Horas Rainer Burgkart Rüdiger von Eisenhart-Rothe Manuel Weissenberger Maximilian Rudert Boris Michael Holzapfel |
author_sort |
Peter Michael Prodinger |
title |
Revision Arthroplasty Through the Direct Anterior Approach Using an Asymmetric Acetabular Component |
title_short |
Revision Arthroplasty Through the Direct Anterior Approach Using an Asymmetric Acetabular Component |
title_full |
Revision Arthroplasty Through the Direct Anterior Approach Using an Asymmetric Acetabular Component |
title_fullStr |
Revision Arthroplasty Through the Direct Anterior Approach Using an Asymmetric Acetabular Component |
title_full_unstemmed |
Revision Arthroplasty Through the Direct Anterior Approach Using an Asymmetric Acetabular Component |
title_sort |
revision arthroplasty through the direct anterior approach using an asymmetric acetabular component |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2020-09-01 |
description |
Despite increasing numbers of primary hip arthroplasties performed through the direct anterior approach (DAA), there is a lack of literature on DAA revision arthroplasty. The present study was performed in order to evaluate outcomes and revision rates after revision through the DAA using an asymmetric acetabular component with optional intra- and extramedullary fixation. In a retrospective cohort study, we analyzed prospectively collected data of 57 patients (61 hips, 43 female, 18 male) who underwent aseptic acetabular component revision through the DAA with the abovementioned implant system between January 2015 and December 2017. The mean follow-up was 40 months (12–56). Survival rates were estimated using the Kaplan–Meier method. All complications were documented and functional outcomes were assessed pre- and postoperatively. Kaplan–Meier analysis revealed an estimated five-year implant survival of 97% (confidence interval CI 87–99%). The estimated five-year survival with revision for any cause was 93% (CI 83–98%). The overall revision rate was 6.6% (n = 4). Two patients had to undergo revision due to periprosthetic infection (3.3%). In one patient, the acetabular component was revised due to aseptic loosening four months postoperatively. Another patient suffered from postoperative iliopsoas impingement and was treated successfully by arthroscopic iliopsoas tenotomy. Two (3.3%) of the revised hips dislocated postoperatively. The mean Harris Hip Score improved from 35 (2–66) preoperatively to 86 (38–100) postoperatively (<i>p</i> < 0.001). The hip joint’s anatomical center of rotation was restored at a high degree of accuracy. Our findings demonstrate that acetabular revision arthroplasty through the DAA using an asymmetric acetabular component with optional intra- and extramedullary fixation is safe and practicable, resulting in good radiographic and clinical midterm results. |
topic |
anterior approach revision arthroplasty hip joint acetabular bone defect asymmetric implant anatomic center of rotation |
url |
https://www.mdpi.com/2077-0383/9/9/3031 |
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