PRACTICE PEARLS: Is the DAA Appropriate for Revision THA?

    Given the increasing popularity of the direct anterior approach (DAA) for total hip arthroplasty (THA) and the projected triple-figure increase in revision THA procedures by the year 2030, it’s reasonable for surgeons to be asking if the DAA can be used in revision situations, said Harpal (Paul) Khanuja, MD, from Johns Hopkins University, at ICJR’s Revision Hip & Knee Course.

    Although Dr. Khanuja uses the DAA for about 90% of his primary THAs, he admitted that he rarely uses it for revision procedures, preferring to use the same approach that was used in the primary procedure.

    So, when he was asked to speak on this topic at the Revision Hip & Knee Course, he investigated the literature to see what other surgeons had reported.

    He found that few studies on revision THA mention the approach that was used. Studies that did include the approach reported acceptable short-term complication rates for revision THA through the DAA, he said, and described how to extend the relatively small DAA incision used in primary THA to allow visualization of the acetabulum and distal femur in a revision procedure.

    The answer, he concluded, is yes, the DAA can be used in revision THA, provided the surgeon is experienced in the approach, knows how to extend the incision without jeopardizing underlying structures, and feels comfortable using the approach for a revision procedure.

    Click the image above to watch Dr. Khanuja’s presentation and find out how to proximally and distally extend the incision for a revision THA through the DAA.