Direct Anterior Approach for Revision Total Hip Arthroplasty: Anatomy and Surgical Technique.

There has been increased interest and literature on the efficacy of direct anterior approach (DAA) for total hip arthroplasty (THA). Developments in surgical technique and instrumentation, along with exposure earlier in orthopaedic residency training, may augment the adoption of this approach among practicing orthopaedic surgeons. With the increasing number of primary THA performed through the DAA, understanding the indications and techniques associated with revision THA via the DAA has proved increasingly important. Patient positioning, understanding surgical anatomy and extensile maneuvers, and applying key reconstructive methods are essential for obtaining adequate exposure and fixation. Acetabular exposure can be facilitated through capsular and soft-tissue release, along with extensile approaches to the pelvis and acetabulum. Extensile distal extension can be performed for safe access to the femur, including extended femoral osteotomies. The purpose of this review is to describe indications, surgical anatomy, intraoperative tips, clinical outcomes, and complications after DAA for revision THA.

The Extended Direct Anterior Approach for Column Augmentation in the Deficient Pelvis: A Novel Surgical Technique, and Case Series Report.

BACKGROUND: Anterior column deficiency of the pelvis may pose a serious threat to the stability of the acetabular component after total hip arthroplasty and, thus, jeopardize the overall success of the procedure. METHODS: After Institutional Review Board approval, a retrospective review was undertaken to identify all patients undergoing revision total hip arthroplasty with anterior column augmentation through an extended direct anterior approach. Demographics and surgical details were collected, and subjects were followed for a 2-year minimum period to measure patient outcomes and to evaluate for the stability of construct fixation. A novel surgical procedure description was provided and supplemented with an illustrative case example. RESULTS: At 2 years post augmentation, patients had favorable functional outcomes with radiologic evidence of stable fixation. CONCLUSION: Proximal extension of the direct anterior approach to the hip can facilitate anterior column access and augmentation to improve stability of the hip reconstruction. This treatment may be an alternative to spanning constructs such as cup-cage constructs and custom implants, affording the potential for long-term biologic fixation. Further investigation into this technique is warranted.

Rehabilitation following anterior approach total hip arthroplasty in a 49-year-old female: a case report.

Over 230,000 total hip arthroplasties (THA) are performed annually, and many of these patients will seek or be referred to a physical therapist to assist them in their recovery. Improvements in understanding of joint replacement technology have allowed earlier weight bearing and return to function. With the anterior surgical approach, patients are permitted weight bearing as tolerated immediately after surgery and can resume nearly all prior activities upon returning home. This case report describes the home-based physical therapy management of a 49-year-old female following a left THA using an anterior surgical approach. This report also includes a description of the functional based protocol and hip assessment scale used. The rehabilitation program was initiated 4 days postoperatively and consisted of a patient-oriented and functional approach. Seventeen days after surgery and seven home visits, the patient exhibited a normal gait pattern, was walking 20 minutes continuously, safely negotiating stairs, and had resumed normal household activities. The subject of this case report was relatively young, highly motivated, and the outcomes presented may not be generalized or expected of other patients following anterior approach THA. Additional studies are needed to determine long-term effects of this surgical approach and postoperative home-based rehabilitation program.

Use of the Fitmore® hip stem bone-preserving system for the minimally invasive anterior-supine approach in hip replacement.

Total hip arthroplasty through a single-incision anterior approach is a minimally invasive surgical (MIS) technique that allows component placement without violation of the posterior hip capsule or "hip deltoid." This allows faster recovery without dislocation precautions. The Fitmore® hip stem (Zimmer, Warsaw, Ind) is a bone-conserving stem designed for use in MIS techniques. The technique described here is a single-incision anterior approach with the Fitmore system using a special orthopedic table.

Table-skeletal fixation as an adjunct to pelvic ring reduction.

The reduction of displaced pelvic ring injuries remains a technical challenge, especially when treatment is delayed. A pelvic frame (Orthopaedic Systems Inc, Union City, California) provides a means of external skeletal fixation, rigidly stabilizing the intact hemipelvis to the operating room table. The fractured and displaced fragments can then be manipulated around the securely fixed uninjured hemipelvis, allowing the application of more directions and magnitudes of force for reduction maneuvers than allowed by the traditional means of pelvic reduction. The surgical technique and 1 case each of an acute fracture and pelvic nonunion/malunion are presented.