The direct anterior approach (DAA) is an established approach for total hip arthroplasty (THA) but has been sparingly tried for revisions. The purpose of this study was to examine the available literature in order to consolidate information available on revision THA using the DAA. A PubMed, Embase, and Scopus search was performed using relevant keywords. Studies reporting on patients undergoing revision THA using DAA were included for analysis. In a review of the literature, nine studies matched the pre-decided inclusion criteria with 319 hip joints undergoing revision THA. Mean follow-up of all included studies was 34 months. The indications of revision after primary THA in decreasing order were aseptic loosening (53%), prosthetic joint infection (20.7%), peri-prosthetic fracture (16.9%), dislocation (7.2%), psoas impingement (1.9%), polyethylene wear (1.2%), pain (0.6%), and instability (0.3%). Of the 319 revisions evaluated, 107 underwent a stem revision, 142 underwent cup revision, 49 underwent a combined revision, and 21 underwent isolated liner/head change. A statistically significant improvement in functional score (P<0.05) was observed for all studies reporting on functional outcomes. A low complication rate (51/319, 16.0%), which includes dislocation (12), infection (12), loosening of the acetabular shell (5), peri-prosthetic fractures (6), haematoma (4), and transient nerve palsy (6), was reported. Based on available level III-IV evidence, DAA appears to be a reliable alternative for revision of the failed hip arthroplasty with acceptable complication rates. Evidence of a higher quality is needed to further characterize its role in revision scenarios.

INTRODUCTIONTotal knee arthroplasty (TKA) is one of the most successful orthopaedic procedures to date. It is estimated that over 130,000 of TKAs are performed in the United States every year. Whilst the procedure is safe, it nevertheless carries a risk of perioperative mortality and morbidity. This study aimed to report the mortality rate within 30 days after a TKA, as well as to assess the incidence of early postoperative morbidities.

MATERIALS AND METHODSWe reviewed a total of 2219 TKAs performed by multiple surgeons in our centre from 1998 to 2001. All mortalities within 30 days of a TKA were recorded. Morbidities such as infection, thromboembolic phenomenon, and any re-admissions within 30 days of operation or 15 days of discharge were recorded.

RESULTSThe mortality rate within 30 days of a TKA was 0.27% (6 of 2219 patients). The incidence of early postoperative infection was 1.8%, of which 1.44% were superficial and 0.36% were deep infections. There were 3 cases (0.13%) of pulmonary embolism and 22 cases (0.99%) of deep vein thrombosis.

CONCLUSIONSThe 30-day mortality rate, and the incidence of infection after TKA performed in our institution is comparable to other centres around the world, and further emphasises that TKA is a safe procedure. However, the small number of mortalities in this study does not allow us to identify a predominant cause of perioperative mortality.

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee ; adverse effects ; mortality ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Mortality ; trends ; Patient Readmission ; Postoperative Complications ; Pulmonary Embolism ; Retrospective Studies ; Thromboembolism ; Treatment Failure ; Venous Thrombosis