Acetabular Total Hip Arthroplasty Revision: A Summary of Operative Factors, Outcomes, and Comparison of Approaches

Background Revision total hip arthroplasty (THA) presents a greater risk to patients than primary THA, and surgical approach may impact outcomes. This study aimed to summarize acetabular revisions at our institution and to compare outcomes between direct anterior and posterior revision THA. Methods A series of 379 acetabular revision THAs performed from January 2010 through August 2022 was retrospectively reviewed. Preoperative, perioperative, and postoperative factors were summarized for all revisions and compared between direct anterior and posterior revision THA. Results The average time to acetabular revision THA was 10 years (range, 0.04 to 44.1), with mechanical failure (36.7%) and metallosis (25.6%) being the most prevalent reasons for revision. No differences in age, body mass index (BMI), or sex were noted between groups. Anterior revision patients had a significantly shorter length of stay (2.2 vs. 3.2 days, P= 0.003) and rate of discharge to a skilled nursing facility (7.5 vs 25.2%, P = 0.008). In the 90-day postoperative period, 9.2% of patients returned to the emergency department (n = 35) and twelve patients (3.2%) experienced a dislocation. There were 13.2% (n = 50) of patients having a re-revision during the follow-up period with a significant difference between anterior and posterior approaches (3.8 vs. 14.7% respectively, P=0.049). Conclusion This study provides some evidence that the anterior approach may be protective against SNF discharge and re-revision and contributes to decreased lengths of stay. We recommend surgeons select the surgical approach for revision THA based on clinical preferences and patient factors.