Does Approach Matter? Direct Anterior versus Posterior Approach in Conversion Total Hip Arthroplasty

Abstract

Background: Conversion total hip arthroplasty (THA) after prior hip surgery is generally associated with higher rates of complications when compared to primary THA. There is a paucity of evidence examining the influence of surgical approach on outcomes of conversion THA. This study compares complication rates between direct anterior approach (DAA) and posterior approach (PA) in patients with prior hip or acetabular fracture fixation undergoing conversion THA.

Methods: Records were reviewed for patients undergoing conversion total hip arthroplasty with prior hip or acetabular fracture fixation from January 1, 2006 to June 30, 2023 at a single institution. Complication rates were assessed at 90 days and at final follow-up. A total of 104 patients were included in the study, with 75 in the PA cohort and 29 in the DAA cohort.

Results: There were no significant differences in complication rates between cohorts at both 90 days and at final follow-up (mean 754 days) including rates of dislocation, intraoperative fracture, postoperative periprosthetic fracture, periprosthetic joint infection, superficial surgical site infection, and wound dehiscence.

Conclusion: Conversion THA on patients with prior hip or acetabular fracture fixation can be successful from either an anterior or posterior approach. Each approach may offer unique benefits and disadvantages depending on patient-specific factors. Further research is needed to evaluate long-term outcomes and complication rates associated with each surgical approach. Level of Evidence: IV.

Keywords: arthroplasty; dislocation; surgical technique; wound infection.