Kerboull-type plate in a direct anterior approach for severe bone defects at primary total hip arthroplasty: technical note

Abstract

Introduction: For cases with extensive acetabular bone defects, we perform surgery combining the Kerboull-type (KT) plate and bone graft through direct anterior approach (DAA) in primary total hip arthroplasty (THA) requiring acetabular reconstruction as minimally invasive surgery. This paper provides the details of the surgical procedure. Methods: The basic structure of the Kerboull-type plate is a cruciform plate. Since the hook of the Kerboull-type plate has to be applied to the tear drop, a space for it was exposed. The tear drop is located in the anterior lower region in surgery through DAA in supine position. It was also confirmed by fluoroscopy as needed. The bone grafting was performed using an auto- or allogeneic femoral head for bone defects in the weight-bearing region of the hip joint. Results: Of 563 patients who underwent primary THA between 2012 and 2014, THA using the KT plate through DAA was performed in 21 patients (3.7%). The mean duration of postoperative follow-up was 31.8 months. The mean operative time was 188.4 min, and the mean blood loss was 770 g. The patients became able to walk independently after 2.4 days on average (1–4 days). On clinical evaluation, the modified Harris Hip Score was 45.6 ± 12.4 before surgery, and it was significantly improved to 85.3 ± 8.97 on the final follow-up. Discussion: DAA is a true intermuscular approach capable of conserving soft tissue. Since it is applied in a supine position, fluoroscopy can be readily used, and it was very useful to accurately place the plate.

Total hip arthroplasty with reconstruction of acetabulum through direct anterior approach for metastatic bone disease of acetabulum combined with pathological proximal femoral neck fracture: A case report

“…Therefore, Wegrzyn et al advocated reconstructing the acetabulum with the use of a Kerboull cross-plate, which does not rely on bone ingrowth for stability and reduces the mechanical forces applied to the periacetabular bone with fixation over a large surface area of intact pelvic bone, increasing the elasticity of the reconstruction [ 2 ]. Matsumoto et al reported the details of surgical acetabular reconstruction using a KT plate through the DAA for patients with an extensive acetabular bone defect [ 3 ]. No serious complications, such as dislocation, infection, or periprosthetic femoral fracture, occurred in any patient after surgery [ 3 ].…”

“…Matsumoto et al reported the details of surgical acetabular reconstruction using a KT plate through the DAA for patients with an extensive acetabular bone defect [ 3 ]. No serious complications, such as dislocation, infection, or periprosthetic femoral fracture, occurred in any patient after surgery [ 3 ]. Furthermore, in this case, antibiotic-laden bone cement was used at the time of definitive component implantation to prevent prosthetic joint infection.…”

“…Several studies have demonstrated the effectiveness of acetabular reconstruction using a Kerboull-type (KT) plate through the direct anterior approach (DAA), which is a minimally invasive surgical approach for extensive acetabular bone defects [ 3 , 4 ]. We performed THA with acetabular reconstruction through the DAA in a patient with metastatic bone disease of the acetabulum combined with pathological proximal femoral neck fracture.…”

Posterior versus direct anterior approach in revision hip arthroplasty using Kerboull-type plate

“…The effectiveness of fluoroscopy for accurate implant placement has been demonstrated, and we always use it when DAA is employed [22]. We previously reported the detailed surgical procedure of acetabular reconstruction with the Kerboull-type plate through DAA [23]. No serious complications, such as dislocation, infection, or periprosthetic femoral fracture, occurred in any patient after surgery.…”

Hip arthroplasty for unstable femoral trochanteric fractures using the direct anterior approach

“…For THA, a dual mobility cup was used for the acetabular component: the MDM (Stryker Orthopaedics, Mahwah, New Jersey, USA) in 4 patients and the G7 (Zimmer Biomet, Warsaw, Indiana, USA) in 14 patients. Surgery was performed through DAA in the supine position using a traction table and intraoperative uoroscopy [13] (Fig. 2).…”