Mid-term Follow-up of the Direct Anterior Approach in Acetabular Revision Hip Arthroplasty Using a Reconstruction Cage With Impaction Grafting

Severe acetabular bone loss is often treated with reconstruction cages and impaction grafting using allograft bone. Accurate implant positioning is crucial for successful clinical and radiological outcomes. The direct anterior approach (DAA) is a standard approach for primary total hip arthroplasty (THA) that is being used more frequently for revision THA. The aim of this study was to report midterm clinical and radiological outcomes of acetabular revision arthroplasty using the DAA to address large acetabular defects by using a reconstruction cage and impaction grafting.

Acetabular cup revisions were performed in 64 patients (64 hips) with severe acetabular bone loss. All patients received reconstruction cages with impaction grafting via the DAA. The stem was also revised in 22 patients. Complications, radiological, and functional outcomes were assessed.

Six of the 64 patients were revised at a mean follow-up of 27.6 months (range, 11-84 months), two each for implant failure, infection, and recurrent dislocation. One hip showed the radiological failure of the implant, but the patient was asymptomatic and was not revised. The median Western Ontario McMasters Osteoarthritis Score (WOMAC) for the cohort overall improved significantly ( P < .01) by the latest follow-up compared with preoperative scores.

Good midterm outcomes can be obtained with the DAA for acetabular cup revisions done to address severe acetabular bone loss by using reconstruction cages and impaction grafting. The number of complications was within the expected range for this type of revision procedure at midterm follow-up, and dislocation rates were low.