Minimizing Instability in Isolated Head and Liner Exchange With the Direct Anterior Approach Using a Capsular-Sparing Technique.

Background: Dislocation is a common complication after head and liner exchange. Although surgical approach has been shown to influence instability rate following primary total hip replacement, the same has not been demonstrated for head and liner exchange. The effect of additional soft tissue release to achieve exposure in revision surgery has been implicated in this finding. We have sought to describe and report the effects on postoperative stability of a capsular sparing technique of head and liner exchange with the direct anterior approach, in a single surgeon case series. Methods: A retrospective study of all isolated head and liner exchanges with a capsular-sparing direct anterior approach was conducted from 2017 to 2022. Patients without a 2-year follow-up or prior revision on the ipsilateral hip were excluded. A total of 39 hips in 36 patients were identified, with the most common indication for HLE being, liner wear + osteolysis in 44% of patients. The mean follow-up was 29.8 months. Results: At the latest follow-up there were zero dislocations. Two patients required re-revision for acetabular component loosening, yielding a 95% survivorship free of re-revision at latest follow-up. A 36-mm head was utilized in 65% and a neutral liner in 85% percent of the hips. The average Hip Disability and Osteoarthritis Outcome Score for Joint Replacement score at latest follow-up was 80.81. Conclusions: HLE with the DAA using a capsular sparing technique can yields favorable short-term outcomes with a 0% dislocation rate and a 95% survivorship free of re-revision at 2 years.