Femoral revision with the direct anterior approach

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dc.contributor.authorThaler, Martinen
dc.contributor.authorCorten, Kristoffen
dc.contributor.authorNogler, Michaelen
dc.contributor.authorHolzapfel, Boris Michaelen
dc.contributor.authorMoskal, Joseph T.en
dc.date.accessioned2024-01-19T13:57:17Zen
dc.date.available2024-01-19T13:57:17Zen
dc.date.issued2022-06en
dc.description.abstractObjective: The advantages of the direct anterior approach (DAA) in primary total hip arthroplasty as a minimally invasive, muscle-sparing, internervous approach are reported by many authors. Therefore, the DAA has become increasingly popular for primary total hip arthroplasty (THA) in recent years, and the number of surgeons using the DAA is steadily increasing. Thus, the question arises whether femoral revisions are possible through the same interval. Indications: Aseptic, septic femoral implant loosening, malalignment, periprosthetic joint infection or periprosthetic femoral fracture. Contraindications: A draining sinus from another approach. Surgical technique: The incision for the primary DAA can be extended distally and proximally. If necessary, two releases can be performed to allow better exposure of the proximal femur. The DAA interval can be extended to the level of the anterior superior iliac spine (ASIS) in order to perform a tensor release. If needed, a release of the external rotators can be performed in addition. If a component cannot be explanted endofemorally, and a Wagner transfemoral osteotomy or an extended trochanteric osteotomy has to be performed, the skin incision needs to be extended distally to maintain access to the femoral diaphysis. Postoperative management: Depending on the indication for the femoral revision, ranging from partial weight bearing in cases of periprosthetic fractures to full weight bearing in cases of aseptic loosening. Results: In all, 50 femoral revisions with a mean age of 65.7 years and a mean follow-up of 2.1 years were investigated. The femoral revision was endofemoral in 41 cases, while a transfemoral approach with a lazy‑S extension was performed in 9 patients. The overall complication rate was 12% (6 complications); 3 patients or 6% of the included patients required reoperations. None of the implanted stems showed a varus or valgus position. There were no cases of mechanical loosening, stem fracture or subsidence. Median WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score before surgery improved significantly from preoperative (52.5) to postoperative (27.2).en
dc.description.versionPublished versionen
dc.format.extentPages 189-202en
dc.format.extent14 page(s)en
dc.format.mimetypeapplication/pdfen
dc.identifier.doihttps://doi.org/10.1007/s00064-022-00768-5en
dc.identifier.eissn1439-0981en
dc.identifier.issn0934-6694en
dc.identifier.issue3en
dc.identifier.otherPMC9197934en
dc.identifier.other10.1007/s00064-022-00768-5 (PII)en
dc.identifier.pmid35641790en
dc.identifier.urihttps://hdl.handle.net/10919/117409en
dc.identifier.volume34en
dc.language.isoenen
dc.publisherUrban & Vogelen
dc.relation.urihttps://www.ncbi.nlm.nih.gov/pubmed/35641790en
dc.rightsCreative Commons Attribution 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.subjectDirect anterior approachen
dc.subjectRevision total hip arthroplastyen
dc.subjectFemoral revisionen
dc.subjectApproach extensionsen
dc.subjectModular stemen
dc.subject.meshFemuren
dc.subject.meshHumansen
dc.subject.meshTreatment Outcomeen
dc.subject.meshArthroplasty, Replacement, Hipen
dc.subject.meshReoperationen
dc.subject.meshRetrospective Studiesen
dc.subject.meshProsthesis Designen
dc.subject.meshHip Prosthesisen
dc.subject.meshAgeden
dc.subject.meshPeriprosthetic Fracturesen
dc.titleFemoral revision with the direct anterior approachen
dc.title.serialOperative Orthopädie und Traumatologieen
dc.typeArticle - Refereeden
dc.type.dcmitypeTexten
dc.type.otherArticleen
dc.type.otherJournalen
dcterms.dateAccepted2021-01-17en
pubs.organisational-group/Virginia Techen
pubs.organisational-group/Virginia Tech/VT Carilion School of Medicineen
pubs.organisational-group/Virginia Tech/VT Carilion School of Medicine/Orthopedicen
pubs.organisational-group/Virginia Tech/VT Carilion School of Medicine/Orthopedic/General Orthopedicsen

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