title: The Direct Anterior Approach is Associated With Early Revision Total Hip Arthroplasty.
abstract: The direct anterior approach for total hip arthroplasty (THA) has generated increased interest recently. The purpose of this study was to compare the duration to failure and reasons for revision of primary THA performed elsewhere and subsequently revised at our institution after the direct anterior vs other nonanterior surgical approaches to the hip.
  
  
  
  All primary THAs performed elsewhere and referred to our institution for revision were divided into the direct anterior approach (30 cases) or nonanterior approach groups (100 cases, randomly selected from 453 cases) based on the original surgical approach. Because all primary direct anterior THAs were originally performed after 2004 to eliminate temporal bias, we identified a subset of the nonanterior group in which the primary THA was performed after 2004 (known as the recent nonanterior group, 100 cases, randomly selected from 169 available cases).
  
  
  
  The mean duration from primary to revision THA was 3.0 ± 2.7 years (direct anterior approach), 12.0 ± 8.8 years (nonanterior approach), and 3.6 ± 2.8 years (recent nonanterior), respectively. There was a significant difference in time to revision between the direct anterior and nonanterior approach groups (P < .001). Aseptic loosening of the stem was significantly more frequent with the direct anterior approach group (9/30, 30.0%) when compared with the nonanterior group (8/100, 8.0%, P = .007) and the recent nonanterior group (7/100, 7.0%, P = .002).
  
  
  
  Revision of the femoral component for aseptic loosening is more commonly associated with the direct anterior approach in our referral practice.
authors.affiliation: Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan; Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, Stanford School of Medicine, Redwood City, California.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Eto
authors.affiliation: Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, Stanford School of Medicine, Redwood City, California.
authors.forename: Katherine
authors.initials: K
authors.lastname: Hwang
authors.affiliation: Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, Stanford School of Medicine, Redwood City, California.
authors.forename: James I
authors.initials: JI
authors.lastname: Huddleston
authors.affiliation: Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, Stanford School of Medicine, Redwood City, California.
authors.forename: Derek F
authors.initials: DF
authors.lastname: Amanatullah
authors.affiliation: Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, Stanford School of Medicine, Redwood City, California.
authors.forename: William J
authors.initials: WJ
authors.lastname: Maloney
authors.affiliation: Department of Orthopaedic Surgery, Stanford University Medical Center Outpatient Center, Stanford School of Medicine, Redwood City, California.
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Goodman
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure / Q000209:etiology*; D012017:Referral and Consultation; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: anterolateral approach; direct anterior approach; hip arthroplasty; posterior approach; revision; surgical approach