Outcomes Following Direct Anterior Approach Total Hip Arthroplasty: A Contemporary Multicenter Study.

IF 4.4 1区医学 Q1 ORTHOPEDICS

Journal of Bone and Joint Surgery, American Volume Pub Date : 2024-12-23 DOI:10.2106/JBJS.24.00132

Jacob M Wilson, Matthew L Hadley, Dirk Larson, Cameron K Ledford, Joshua S Bingham, Cody C Wyles, Michael J Taunton

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引用次数: 0

Abstract

Background: The direct anterior approach (DAA) is a popular approach for primary total hip arthroplasty (THA). However, the contemporary outcomes for DAA THA need further elucidation. Therefore, we aimed to describe implant survivorship, complications, and clinical outcomes after DAA THA.

Methods: From our multi-institutional total joint registry, 3,184 patients who had undergone 3,698 primary DAA THA between 2010 and 2019 were identified. The identified patients had a mean age of 65 years and a mean body mass index (BMI) of 29 kg/m2, and 53% of patients were female. The indications for revision and reoperation and the incidence of complications were collected and analyzed. Potential risk factors, including age, sex, BMI, and high-volume compared with low-volume operating surgeons, were examined. Descriptive statistics and Kaplan-Meier survivorship with Cox regression analyses were performed.

Results: At 10 years following primary DAA THA, the cohort had 96% (95% confidence interval [CI], 95% to 98%) survivorship free of any revision and 94% (95% CI, 92% to 96%) survivorship free of any reoperation. The leading indications for revision were periprosthetic joint infection (PJI) (n = 24; 5-year cumulative incidence, 0.93% [95% CI, 0.6% to 1.5%]), periprosthetic fracture (n = 20; 5-year cumulative incidence, 0.62% [95% CI, 0.4% to 1.0%]), and aseptic loosening (n = 14; 11 femoral, 3 acetabular; 5-year cumulative incidence, 0.84% [95% CI, 0.5% to 1.5%]). A BMI of ≥40 kg/m2 was found to be significantly associated with PJI (hazard ratio [HR], 6.4; p < 0.001), reoperation (HR, 3.5; p < 0.001), and nonoperative complications (HR, 2.3; p = 0.018). Survivorship free of recurrent instability was 99.6% (95% CI, 99.4% to 99.8%) at 5 and 10 years, and the cumulative incidence of revision for instability was 0.14% at 5 years.

Conclusions: In one of the largest published series to date, survivorship following DAA THA was satisfactory at early to intermediate follow-up. The leading indications for revision were PJI, periprosthetic fracture, and aseptic loosening. Instability after DAA THA was uncommon and infrequently led to revision. As a note of caution, a BMI of ≥40 kg/m2 was identified as a risk factor for adverse outcome after DAA THA.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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直接前路全髋关节置换术的结果：一项当代多中心研究。

背景：直接前路入路（DAA）是原发性全髋关节置换术（THA）的常用入路。然而，DAA的当代结果需要进一步阐明。因此，我们的目的是描述DAA THA后种植体的存活、并发症和临床结果。方法：从我们的多机构联合总登记中，确定了2010年至2019年期间接受了3,698例原发性DAA THA的3,184例患者。确诊患者平均年龄65岁，平均体重指数（BMI）为29 kg/m2，女性占53%。收集并分析手术适应证及并发症的发生情况。潜在的危险因素，包括年龄、性别、身体质量指数、大手术量与小手术量的比较。描述性统计和Kaplan-Meier生存分析采用Cox回归分析。结果：在首次DAA THA后10年，该队列有96%（95%置信区间[CI]， 95%至98%）无任何修订的生存率，94% （95% CI， 92%至96%）无任何再手术的生存率。翻修的主要适应症是假体周围关节感染（PJI） (n = 24；5年累计发病率，0.93% [95% CI, 0.6% ~ 1.5%])，假体周围骨折(n = 20；5年累积发病率，0.62% [95% CI, 0.4% - 1.0%])和无菌性松动(n = 14；11只股骨，3只髋臼；5年累计发病率，0.84% [95% CI, 0.5% ~ 1.5%])。BMI≥40 kg/m2与PJI显著相关(风险比[HR]， 6.4；p < 0.001)，再手术(HR, 3.5；p < 0.001)，非手术并发症(HR, 2.3；P = 0.018)。5年和10年无复发性不稳定的生存率为99.6% (95% CI， 99.4%至99.8%)，5年不稳定修正的累积发生率为0.14%。结论：在迄今为止发表的最大的系列研究之一中，DAA THA术后早期至中期随访的生存率令人满意。翻修的主要适应症是PJI、假体周围骨折和无菌性松动。DAA后的不稳定并不常见，很少导致翻修。值得注意的是，BMI≥40 kg/m2被确定为DAA THA后不良结果的危险因素。证据等级：治疗性IV级。参见《作者说明》获得证据等级的完整描述。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Bone and Joint Surgery, American Volume 医学-外科

CiteScore

8.90

自引率

7.50%

发文量

660

审稿时长

1 months

期刊介绍： The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.