Distal Extension of the Direct Anterior Approach to the Hip: A Cadaveric Feasibility Study

Ghijselings, Stijn; Driesen, Ronald B.; Simon, Jean‐Pierre; Corten, Kristoff

doi:10.1016/j.arth.2016.07.003

Cited by 20 publications

(9 citation statements)

References 19 publications

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“…The authors routinely extend the original approach used for DAA distally while maintaining the same dissection interval for all periprosthetic femoral fracture cases requiring revision of the femoral component. This technique described by Ghijselings et al 39) in their cadaveric technique description is an alternative way to gain additional exposure of the femur during the DAA and is based on precise knowledge of the periarticular neurovascular structures 26 27) . Femoral revisions using a posterior hip joint method, along with the release of external rotators, traditionally show a dislocation rate of up to 30% in literature 40 41) .…”

Section: Discussionmentioning

confidence: 99%

“…The learning curve for this technique is undoubtedly steep and surgeons wishing to perform this approach need to have performed a significant number of primary hip arthroplasties using this approach 49) . The most recent clinical and cadaver studies also indicate increased use of DAA for acetabular and femoral revisions 39) . Comparative studies with a more robust design are needed to prove superiority or equivalence of DAA over conventional approaches for revision arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Direct Anterior Approach for Revision Total Hip Arthroplasty: A Systematic Review

Singh¹,

Khurana

Gupta

2021

Hip & Pelvis

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The direct anterior approach (DAA) is an established approach for total hip arthroplasty (THA) but has been sparingly tried for revisions. The purpose of this study was to examine the available literature in order to consolidate information available on revision THA using the DAA. A PubMed, Embase, and Scopus search was performed using relevant keywords. Studies reporting on patients undergoing revision THA using DAA were included for analysis. In a review of the literature, nine studies matched the pre-decided inclusion criteria with 319 hip joints undergoing revision THA. Mean follow-up of all included studies was 34 months. The indications of revision after primary THA in decreasing order were aseptic loosening (53%), prosthetic joint infection (20.7%), peri-prosthetic fracture (16.9%), dislocation (7.2%), psoas impingement (1.9%), polyethylene wear (1.2%), pain (0.6%), and instability (0.3%). Of the 319 revisions evaluated, 107 underwent a stem revision, 142 underwent cup revision, 49 underwent a combined revision, and 21 underwent isolated liner/head change. A statistically significant improvement in functional score ( P <0.05) was observed for all studies reporting on functional outcomes. A low complication rate (51/319, 16.0%), which includes dislocation (12), infection (12), loosening of the acetabular shell (5), peri-prosthetic fractures (6), haematoma (4), and transient nerve palsy (6), was reported. Based on available level III-IV evidence, DAA appears to be a reliable alternative for revision of the failed hip arthroplasty with acceptable complication rates. Evidence of a higher quality is needed to further characterize its role in revision scenarios.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of Direct Anterior Approach for Revision Total Hip Arthroplasty: A Systematic Review

Singh¹,

Khurana

Gupta

2021

Hip & Pelvis

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“…The authors advocated using the subvastus approach to pass cerclage wires as a safer route for the neurovascular structures. Ghijselings et al 68 conducted a cadaveric anatomical study and demonstrated that the position of the distal neurovascular bundles is, for the most part, stable in reference to anatomical landmarks, and predictable. They concluded that distal extension is feasible and proximal femoral cerclage wiring can be safely performed.…”

Section: Disadvantagesmentioning

confidence: 99%

Total hip arthroplasty through an anterior approach

2018

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Total hip arthroplasty through an anterior approach has been increasing in popularity amongst surgeons and patients.Anterior approach hip arthroplasty seems to offer improved early outcomes in terms of pain, rehabilitation and length of stay.No difference in long-term outcomes has been shown between anterior and posterior or lateral approaches.Proper formal training, utilization of fluoroscopy and adequate experience can mitigate risks of complications and improve early and medium-term outcomes.Cite this article: EFORT Open Rev 2018;3:574-583. DOI: 10.1302/2058-5241.3.180023.

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“…Complications and reconstruction failure rates are much higher in the revision arthroplasty cohort when compared to those reported in the primary arthroplasty literature. 31–34 As is the case with primary THA, dislocation remains a leading mode of failure after revision hip arthroplasty despite improvements in technology and modern techniques. 31,35,36…”

Section: Discussionmentioning

confidence: 99%

Postoperative acetabular component position in revision hip arthroplasty: a comparison of the anterior and posterior approaches

et al. 2020

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Background: While previously considered unsuitable for revision total hip arthroplasty (rTHA), the direct anterior approach (DAA) can be extended to allow for safe acetabular component revision. In primary hip arthroplasty, the DAA and its associated fluoroscopy, has been shown to produce more acceptable component positioning. However, there is little data comparing the DAA to the posterior approach (PA) for rTHA. We hypothesised that, the DAA with intraoperative fluoroscopy would allow for more precise acetabular component positioning when compared to those performed using a PA. Methods: 50 consecutive patients (25 DAA and 25 PA) undergoing rTHA were included. Radiographic analysis of postoperative acetabular component position was then performed. Univariate and multivariate analyses was performed to assess the contribution of approach on cup positioning inside classically defined “safe zones”. Results: Baseline patient characteristics were similar. The PA was associated with more cups placed outside the Lewinnek (48% vs. 12%, p = 0.005) and the Danoff (52% vs. 28%, p = 0.083) “safe zones” when compared to the DAA. Multivariate analysis revealed that operative approach was the only patient or surgical factor associated with component position outside of the “safe zones” (Lewinnek [OR = 13.6; 95% CI, 2.12–87.9, p = 0.006] and Danoff [OR = 7.7; 95% CI, 1.48–40.1, p = 0.015]). Conclusion: Our results suggest that the DAA allows for more reproducible and precise cup placement in RTHA. The safe-zone paradigm remains a useful index of accurate cup positioning and the DAA, with use of intraoperative fluoroscopy, offers more consistent acetabular component positioning when compared to the PA.

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Distal Extension of the Direct Anterior Approach to the Hip: A Cadaveric Feasibility Study

Cited by 20 publications

References 19 publications

Evaluation of Direct Anterior Approach for Revision Total Hip Arthroplasty: A Systematic Review

Evaluation of Direct Anterior Approach for Revision Total Hip Arthroplasty: A Systematic Review

Total hip arthroplasty through an anterior approach

Postoperative acetabular component position in revision hip arthroplasty: a comparison of the anterior and posterior approaches

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