The Anterior-Based Muscle-Sparing Approach for Conversion Total Hip Arthroplasty is Safe and Effective.

BACKGROUND

Total hip arthroplasty (THA) after prior hip or acetabular fracture fixation is considered higher risk than primary THA, as studies have shown reduced implant survival and higher infection rates. The anterior-based muscle-sparing (ABMS) approach can potentially reduce some of these risks by utilizing a new surgical interval. The goal of this study is to analyze the efficacy of the ABMS approach for conversion to hip arthroplasty surgery after previous fracture fixation with comparison to posterior approach.

METHODS

This retrospective cohort study included patients with prior hip surgical intervention requiring hardware then converted to a THA using the ABMS or posterior approach at 1 institution between 2013 and 2020. Outcomes studied included postoperative complications, 30-day emergency department visits, 90-day readmission rates, any reoperation and patient-reported outcome measures.

RESULTS

A total of 85 patients (51 male and 34 female) in the ABMS group and 17 patients (9 male and 8 female) in the posterior group were included. Within the ABMS group, the mean age was 65.6 years (±16.2) with a mean body mass index of 27.5 kg/m (±5.4). The average operative time was 85 minutes (±35) and estimated blood loss was 178 mL (±183). There was 1 postoperative complication (dislocation) within 90 days, 1 patient made an emergency department visit within 30 days, and there were 3 readmissions within 90 days; only 1 readmission was orthopaedic in nature. One patient required reoperation (1.2%) over the study period of 5.0 years (±2.1). Patient-reported outcome measures indicate successful return of function. Operative, hospital, and outcome data were similar between patients receiving the ABMS and posterior approach.

CONCLUSIONS

This study is the first to evaluate outcomes of conversion THA using the ABMS approach, when compared to the posterior approach. Our institution's experience demonstrates that the ABMS approach is safe and effective for conversion THA after prior fracture fixation.