Peters Cord J, Dopson Erika, Ross Jeremy A, Goldman Ashton H
Bone and Joint Sports Medicine Institute, Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, USA.
Eastern Virginia Medical School, Norfolk, VA, USA.
Arch Orthop Trauma Surg. 2024 Dec 18;145(1):69. doi: 10.1007/s00402-024-05727-2.
The increased use of the direct anterior approach (DAA) for primary total hip arthroplasty (THA) has extended to revision THA. This systematic review evaluated studies reporting both the utility and clinical outcomes of revision THA using DAA, focusing on studies comparing revision approaches.
A review of the Cochrane Library, EMBASE, and MEDLINE databases identified 577 publications. 538 were excluded after abstract screening. Full-text review identified 21 studies with 1627 patients. All studies were retrospective, level IV evidence. MINORS criteria rated 14 as poor and seven as moderate. Five studies compared DAA to alternative approaches. Meta-analysis was not performed due to significant heterogeneity and lack of comparative studies.
The most common indications for revision were aseptic loosening (n = 929) and polyethylene wear (n = 158). The majority of the studies (n = 11/21) performed primarily acetabular revision or head-liner exchanges. Half the revisions (50.6%; n = 823/1627) included femoral revisions (35.2%; n = 573/1627) or combined femoral-acetabular revisions (15.4%; n = 250/1627). However, 80.6% (n = 462/573) of femoral revisions were from two non-comparative studies. Among the five comparative studies, two included femoral or combined revisions with significantly more performed using the posterior approach. Three of the five comparative studies did not find the DAA protective against postoperative dislocation. The overall complication rate was 14.0%; periprosthetic femoral fracture (n = 106), dislocation (n = 80), and infection (n = 36) were most common. Fourteen studies reported patient-reported outcome measures, demonstrating consistent improvements following revision THA.
Current data on revision DAA THA are limited due to their retrospective nature. They demonstrate the ability to safely perform acetabular and head-liner revisions in carefully selected patients. Comparative studies lack femoral revisions, show a propensity for femoral fractures, and exhibit selection bias. Higher-quality, comparative prospective studies are needed.
PROSPERO: CRD4202236457.
直接前路入路（DAA）在初次全髋关节置换术（THA）中的应用增加，现已扩展到翻修THA。本系统评价评估了报告使用DAA进行翻修THA的效用和临床结果的研究，重点关注比较翻修入路的研究。
对Cochrane图书馆、EMBASE和MEDLINE数据库进行检索，共识别出577篇出版物。摘要筛选后排除538篇。全文审查确定了21项研究，涉及1627例患者。所有研究均为回顾性研究，证据等级为IV级。MINORS标准将14项研究评为差，7项评为中等。5项研究将DAA与其他入路进行了比较。由于显著的异质性和缺乏比较研究，未进行荟萃分析。
翻修的最常见指征是无菌性松动（n = 929）和聚乙烯磨损（n = 158）。大多数研究（n = 11/21）主要进行髋臼翻修或股骨头内衬置换。一半的翻修手术（50.6%；n = 823/1627）包括股骨翻修（35.2%；n = 573/1627）或股骨-髋臼联合翻修（15.4%；n = 250/1627）。然而，80.6%（n = 462/573）的股骨翻修来自两项非比较性研究。在五项比较性研究中，两项包括股骨或联合翻修，其中使用后入路进行的手术明显更多。五项比较性研究中有三项未发现DAA能预防术后脱位。总体并发症发生率为14.0%；假体周围股骨骨折（n = 106）、脱位（n = 80）和感染（n = 36）最为常见。14项研究报告了患者报告的结局指标，表明翻修THA后患者情况持续改善。
由于目前关于DAA翻修THA的数据具有回顾性，因此存在局限性。这些数据表明，在精心挑选的患者中，能够安全地进行髋臼和股骨头内衬翻修。比较性研究缺乏股骨翻修，显示出股骨骨折的倾向，并存在选择偏倚。需要更高质量的比较性前瞻性研究。
PROSPERO：CRD4202236457
