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. 2014 Oct;2(10):100.
doi: 10.3978/j.issn.2305-5839.2014.09.11.

Direct anterior approach for revision total hip arthroplasty

Jorge Manrique  1 , Antonia F Chen  1 , Snir Heller  1 , William J Hozack  1
Affiliations

Direct anterior approach for revision total hip arthroplasty

Jorge Manrique et al. Ann Transl Med. 2014 Oct.

Abstract

Revision total hip arthroplasty (THA) can be successfully performed through the direct anterior (DA) approach. Patient positioning, the surgical approach and specific instruments are important for obtaining adequate exposure. Acetabular exposure can be facilitated by capsular release and correct placement of retractors. Distal and proximal extension of the incision, as well as a femoral extended trochanteric osteotomy (ETO) can be performed to increase femoral exposure. The purposes of this article are to describe the DA approach, provide surgical techniques for revision THA through this approach, and describe the indications, contraindications and complications of this approach.

Keywords: Arthroplasty; direct anterior (DA) approach; extended trochanteric osteotomy (ETO); hip; reoperation; replacement; revision.

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Figures

Figure 1
Figure 1
The skin incision for a revision direct anterior (DA) total hip arthroplasty (THA) can be carried out posteriorly and distally to adequately achieve distal femoral exposure. The proximal mark is the anterior superior iliac spine (ASIS).
Figure 2
Figure 2
Partial extended trochanteric osteotomy (ETO) (14)—a single femoral osteotomy (an episiotomy) is performed initially and may be enough to remove the femoral component.
Figure 3
Figure 3
Full extended trochanteric osteotomy (ETO) (15)—the first bony cut may be continued posteriorly to complete the osteotomy. This may be done with a high speed burr or saw. A posterior hinge is created and the osteotomy is opened using two osteotomes.
See this image and copyright information in PMC

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