Background Isolated acetabular cup revision remains a demanding procedure, with inferior outcomes and higher published re-revision rates (5–20%) compared with primary total hip arthroplasty (pTHA) (2.5% in Switzerland). The direct anterior approach (DAA), increasingly used in pTHA for its minimally invasive nature and rapid recovery, is less established in revision surgery. This study aimed to evaluate the clinical and radiographic outcomes, focusing on patient-reported outcome measures (PROMs), of isolated acetabular cup revisions for mild to moderate acetabular defects performed via the DAA, and to compare them with a matched cohort of pTHA cases using the same approach. Methods Between August 2014 and January 2023, 155 isolated acetabular cup revisions were performed via the DAA with a minimum follow-up of two years. PROMs, radiographic parameters, and revision rates were prospectively collected and retrospectively analyzed. A matched control group of 95 pTHAs performed via DAA served for comparison. Results Most cases presented with Paprosky type I (73%) or II (26%) defects. Bone grafting was required in 68 patients (44%), including 44 (28%) allografts, 19 (12%) autografts, and 5 (3%) augments. Mean cup abduction improved from 47° ± 12° to 40° ± 7°. The Oxford Hip Score increased from 27 ± 10 to 42 ± 9, and the COMI Hip decreased from 6 ± 2 to 2 ± 2 at two years. Re-revision rates were 12% for revisions versus 1% for pTHA. Postoperative well-being was rated good to very good in 78% (59/76) of revision patients and 91% (86/95) of pTHA patients. Conclusion For mild acetabular defects (Paprosky I - II), isolated acetabular cup revision via the DAA provides favorable outcomes but remains associated with lower patient satisfaction and higher re-revision rates compared with pTHA - important aspects for patient counseling.
Vanhees et al. (Thu,) studied this question.