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09.06.2022 | Operative Techniken

Acetabular defect management and revision arthroplasty via the direct anterior approach

verfasst von: Boris Michael Holzapfel, MD PhD FEBOT, Kristoff Corten, Tyler Goldberg, Maximilian Rudert, Michael Nogler, Joseph Moskal, Martin Thaler

Erschienen in: Operative Orthopädie und Traumatologie | Ausgabe 3/2022

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Abstract

Objective

Acetabular revision arthroplasty and osseous defect management through the direct anterior approach (DAA) with or without proximal extension.

Indications

Aseptic or septic component loosening, periacetabular osseous defects, pelvic discontinuity, intrapelvic cup protrusion, anterior pseudotumors, iliopsoas tendonitis, polyethylene wear or iliopsoas abscess.

Contraindications

Clinically relevant gluteal tendon lesions, active infection, morbid obesity, large abdominal pannus, ASA (American Society of Anesthesiologists) score > III, inguinal skin infection.

Surgical technique

Electrocautery dissection is recommended to dissect the Hueter interval and to debulk pericapsular scar tissue. At all times during capsular debulking, it should be made sure not to damage the iliopsoas tendon or the neurovascular bundle. A stepwise releasing sequence can facilitate dislocation of the prosthesis. Most cases can be revised via the standard DAA but certain circumstances require an intra- or extrapelvic extension. Access to the anterior gluteal surface of the ilium can be provided using a “tensor snip”. More posterior access is provided by the extensile extrapelvic approach described by Smith-Petersen. The intrapelvic Levine extension offers access to the entire visceral surface of the ilium and large parts of the anterior column.

Postoperative management

Patient revised via the intra- or extrapelvic extension and patients suffering from extensive soft tissue or osseous defects should undergo postoperative weight-bearing restrictions with 20 kg for 6 weeks.

Results

Based on our studies, there is no limitation on the type of acetabular implant that can be used in DAA revision arthroplasty. Moreover, virtually all types of periacetabular osseous defects can be managed through the approach and its extensions. Acetabular revision arthroplasty via the DAA and its extensions is safe and can result in good midterm results.

Abdel MP, Berry DJ (2019) Current practice trends in primary hip and knee arthroplasties among members f the American association of hip and knee surgeons: a long-term update. J Arthroplasty 34:S24–S27. https://doi.org/10.1016/j.arth.2019.02.006CrossRefPubMed

Kennon R, Keggi J, Zatorski LE, Keggi KJ (2004) Anterior approach for total hip arthroplasty: beyond the minimally invasive technique. J Bone Joint Surg Am 86-A(Suppl 2):91–97. https://doi.org/10.2106/00004623-200412002-00013CrossRef

Rachbauer F, Krismer M (2008) Minimally invasive total hip arthroplasty via direct anterior approach. Oper Orthop Traumatol 20:239–251. https://doi.org/10.1007/s00064-008-1306-yCrossRefPubMed

Patel NN, Shah JA, Erens GA (2019) Current trends in clinical practice for the direct anterior approach total hip arthroplasty. J Arthroplasty 34:1987–1993.e1983. https://doi.org/10.1016/j.arth.2019.04.025CrossRefPubMed

Grob K, Monahan R, Gilbey H, Yap F, Filgueira L, Kuster M (2015) Distal extension of the direct anterior approach to the hip poses risk to neurovascular structures: an anatomical study. J Bone Joint Surg Am 97:126–132. https://doi.org/10.2106/JBJS.N.00551CrossRefPubMed

Nogler MM, Thaler MR (2017) The direct anterior approach for hip revision: accessing the entire femoral diaphysis without endangering the nerve supply. J Arthroplasty 32:510–514. https://doi.org/10.1016/j.arth.2016.07.044CrossRefPubMed

Mast NH, Laude F (2011) Revision total hip arthroplasty performed through the Hueter interval. J Bone Joint Surg Am 93(Suppl 2):143–148. https://doi.org/10.2106/JBJS.J.01736CrossRefPubMed

Moskal JT, Manson TT, Corten K, Yerasimides YJS (2020) Extensile direct anterior approach to the hip for severe acetabular defects. Instr Course Lect 69:15–24PubMed

Prodinger PM, Lazic I, Horas K, Burgkart R, von Eisenhart-Rothe R, Weissenberger M, Rudert M, Holzapfel BM (2020) Revision arthroplasty through the direct anterior approach using an asymmetric acetabular component. J Clin Med. https://doi.org/10.3390/jcm9093031CrossRefPubMedPubMedCentral

10.

Thaler M, Dammerer D, Leitner H, Lindtner RA, Nogler M (2020) Mid-term follow-up of the direct anterior approach in acetabular revision hip arthroplasty using a reconstruction cage with impaction grafting. J Arthroplasty. https://doi.org/10.1016/j.arth.2020.01.004CrossRefPubMed

11.

Thaler M, Lechner R, Dammerer D, Leitner H, Khosravi I, Nogler M (2020) The direct anterior approach: treating periprosthetic joint infection of the hip using two-stage revision arthroplasty. Arch Orthop Trauma Surg 140:255–262. https://doi.org/10.1007/s00402-019-03317-1CrossRefPubMed

12.

Charney M, Paxton EW, Stradiotto R, Lee JJ, Hinman AD, Sheth DS, Prentice HA (2020) A comparison of risk of dislocation and cause-specific revision between direct anterior and posterior approach following elective cementless total hip Arthroplasty. J Arthroplasty. https://doi.org/10.1016/j.arth.2020.01.033CrossRefPubMed

13.

Mjaaland KE, Kivle K, Svenningsen S, Nordsletten L (2019) Do postoperative results differ in a randomized trial between a direct anterior and a direct lateral approach in THA? Clin Orthop Relat Res 477:145–155. https://doi.org/10.1097/CORR.0000000000000439CrossRefPubMed

14.

Bouveau V, Haen T‑X, Poupon J, Nich C (2018) Outcomes after revision of metal on metal hip resurfacing to total arthroplasty using the direct anterior approach. International Orthopaedics (SICOT) 42:2543–2548. https://doi.org/10.1007/s00264-018-3858-2CrossRef

15.

Cogan A, Klouche S, Mamoudy P, Sariali E (2011) Total hip arthroplasty dislocation rate following isolated cup revision using Hueter’s direct anterior approach on a fracture table. Orthop Traumatol Surg Res 97:501–505. https://doi.org/10.1016/j.otsr.2011.04.005CrossRefPubMed

16.

Hasler J, Flury A, Dimitriou D, Finsterwald M, Helmy N, Antoniadis A (2020) Is revision total hip arthroplasty through the direct anterior approach feasible? Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03469-5CrossRefPubMed

17.

Krappinger D, Schwendinger P, Lindtner RA (2019) Fluoroscopically guided acetabular posterior column screw fixation via an anterior approach. Operat Orthop Traumatol 31:503–512. https://doi.org/10.1007/s00064-019-00631-0CrossRef

18.

Hueter C (1883) Fünfte Abtheilung: Die Verletzung und Krankheiten des Hüftgelenks. In: Grundriss der Chirurgie. FCW Vogel, Leipzig., pp 129–200

19.

Spanyer JM, Beaumont CM, Yerasimides JG (2017) The extended direct anterior approach for column augmentation in the deficient pelvis: a novel surgical technique, and case series report. J Arthroplasty 32:515–519. https://doi.org/10.1016/j.arth.2016.08.012CrossRefPubMed

20.

Smith-Peterson MN (1917) A new supra-articular subperiosteal approach to the hip joint. J Bone Joint Surg Am 15:592–595

21.

Nogler M, Mayr E, Krismer M (2012) Der direkte anteriore Zugang in der Revisionshüftendoprothetik. Operat Orthop Traumatol 24:153–164. https://doi.org/10.1007/s00064-011-0113-zCrossRef

22.

Levine MA (1943) Treatment of central fractures of the acetabulum. A case report. J Bone Joint Surg Am 25:902–906

23.

Ganz R, Klaue K, Vinh TS, Mast JW (1988) A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res 232:26–36

24.

Beaule PE, Griffin DB, Matta JM (2004) The Levine anterior approach for total hip replacement as the treatment for an acute acetabular fracture. J Orthop Trauma 18:623–629. https://doi.org/10.1097/00005131-200410000-00008CrossRefPubMed

25.

Australian Orthopaedic Association National Joint Replacement Registry 20th Annual Report 2019. In.

26.

Angerame MR, Fehring TK, Masonis JL, Mason JB, Odum SM, Springer BD (2018) Early failure of primary total hip arthroplasty: is surgical approach a risk factor? J Arthroplasty 33:1780–1785. https://doi.org/10.1016/j.arth.2018.01.014CrossRefPubMed

27.

Charney M, Paxton EW, Stradiotto R, Lee JJ, Hinman AD, Sheth DS, Prentice HA (2020) A comparison of risk of dislocation and cause-specific revision between direct anterior and posterior approach following elective cementless total hip arthroplasty. J Arthroplasty 35:1651–1657. https://doi.org/10.1016/j.arth.2020.01.033CrossRefPubMed

28.

Thaler M, Dammerer D, Hechenberger F, Hormann R, Van Beeck A, Stofferin H (2020) The anatomical course of the lateral femoral cutaneous nerve in relation to various skin incisions used for primary and revision total hip arthroplasty with the direct anterior approach. J Arthroplasty. https://doi.org/10.1016/j.arth.2020.07.052CrossRefPubMed

29.

Hussell JG, Rodriguez JA, Ganz R (1999) Technical complications of the Bernese periacetabular osteotomy. Clin Orthop Relat Res 363: 81–92

30.

Horas K, Arnholdt J, Steinert AF, Hoberg M, Rudert M, Holzapfel BM (2017) Acetabular defect classification in times of 3D imaging and patient-specific treatment protocols. Orthopade 46:168–178. https://doi.org/10.1007/s00132-016-3378-yCrossRefPubMed

31.

Frenzel S, Horas K, Rak D, Boelch SP, Rudert M, Holzapfel BM (2020) Acetabular revision with Intramedullary and extramedullary Iliac fixation for pelvic discontinuity. J Arthroplasty. https://doi.org/10.1016/j.arth.2020.06.067CrossRefPubMed

32.

Claus AM, Engh CA Jr., Sychterz CJ, Xenos JS, Orishimo KF, Engh CA Sr. (2003) Radiographic definition of pelvic osteolysis following total hip arthroplasty. J Bone Joint Surg Am 85:1519–1526. https://doi.org/10.2106/00004623-200308000-00013CrossRefPubMed

33.

Paprosky WG, Perona PG, Lawrence JM (1994) Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6‑year follow-up evaluation. J Arthroplasty 9:33–44. https://doi.org/10.1016/0883-5403(94)90135-xCrossRefPubMed

34.

Yu R, Hofstaetter JG, Sullivan T, Costi K, Howie DW, Solomon LB (2013) Validity and reliability of the Paprosky acetabular defect classification. Clin Orthop Relat Res 471:2259–2265. https://doi.org/10.1007/s11999-013-2844-7CrossRefPubMedPubMedCentral

35.

Munoz M, Gomez-Ramirez S, Kozek-Langeneker S (2016) Pre-operative haematological assessment in patients scheduled for major surgery. Anaesthesia 71(Suppl 1):19–28. https://doi.org/10.1111/anae.13304CrossRefPubMed

36.

Greenky M, Shaner J, Rasouli MR, Han SB, Parvizi J, Hozack WJ (2014) Intraoperative blood salvage in revision total hip arthroplasty: who benefits most? J Arthroplasty 29:1298–1300. https://doi.org/10.1016/j.arth.2013.12.009CrossRefPubMed

37.

Tamaki T, Ninomiya T, Jonishi K, Miura Y, Oinuma K, Shiratsuchi H (2018) Acetabular revision using a Kerboull-type reinforcement device through direct anterior approach. J Orthop Surg 26:230949901878255. https://doi.org/10.1177/2309499018782553CrossRef

38.

Rudert M, Horas K, Hoberg M, Steinert A, Holzapfel DE, Hubner S, Holzapfel BM (2016) The Wuerzburg procedure: the tensor fasciae latae perforator is a reliable anatomical landmark to clearly identify the Hueter interval when using the minimally-invasive direct anterior approach to the hip joint. BMC Musculoskelet Disord 17:57. https://doi.org/10.1186/s12891-016-0908-zCrossRefPubMedPubMedCentral

39.

Hanna A (2017) The lateral femoral cutaneous nerve canal. J Neurosurg 126:972–978. https://doi.org/10.3171/2016.1.JNS152262CrossRefPubMed

40.

Rudert M, Holzapfel BM, Kratzer F, Gradinger R (2010) Standardized reconstruction of acetabular bone defects using the cranial socket system. Oper Orthop Traumatol 22:241–255. https://doi.org/10.1007/s00064-010-9003-zCrossRefPubMed

41.

Van Eemeren A, Vanlommel J, Vandekerckhove M (2020) Acetabular reconstruction with a custom-made triflange acetabular component through direct anterior approach—A case report. J Clin Orthop Trauma 11:S211–S213. https://doi.org/10.1016/j.jcot.2020.02.006CrossRefPubMedPubMedCentral

42.

Moskal JT, Driesen R, Koc BB, Yerasimides J, Corten K (2018) A modified extensile anterior approach to the acetabulum for severe acetabular defects. Orthopedics 41:e194–e201. https://doi.org/10.3928/01477447-20180102-02CrossRefPubMed

43.

Kerboull L (2015) Selecting the surgical approach for revision total hip arthroplasty. Orthop Traumatol Surg Res 101:S171–S178. https://doi.org/10.1016/j.otsr.2014.07.031CrossRefPubMed

Titel: Acetabular defect management and revision arthroplasty via the direct anterior approach
verfasst von: Boris Michael Holzapfel, MD PhD FEBOT
Kristoff Corten
Tyler Goldberg
Maximilian Rudert
Michael Nogler
Joseph Moskal
Martin Thaler
Publikationsdatum: 09.06.2022
Verlag: Springer Medizin
Erschienen in: Operative Orthopädie und Traumatologie / Ausgabe 3/2022
Print ISSN: 0934-6694
Elektronische ISSN: 1439-0981
DOI: https://doi.org/10.1007/s00064-022-00767-6

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Springer Medizin

Acetabular defect management and revision arthroplasty via the direct anterior approach

Abstract

Objective

Indications

Contraindications

Surgical technique

Postoperative management

Results

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Arthroskopie kann Knieprothese nicht hinauszögern

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Update Orthopädie und Unfallchirurgie

Springer Medizin

Abstract

Objective

Indications

Contraindications

Surgical technique

Postoperative management

Results

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