The use of an Antiprotrusio Cage in Acetabular Reconstruction for Periprosthetic Transverse Fracture through a Direct Anterior Approach: A Case Report

Abstract

Introduction: Periprosthetic acetabular fractures following total hip arthroplasty (THA) represent a rare but challenging condition, particularly in patients with previous surgeries through the direct anterior approach (DAA). The case described is, to our knowledge, the first report of a central dislocation of the acetabular component treated using a Burch-Schneider anti-protrusion cage through an extensile DAA. This surgical choice was aimed at minimizing instability and optimizing exposure in a complex revision setting, thus offering an innovative contribution to the orthopedic literature.

Case report: A 64-year-old Caucasian female affected by ischemic vascular transverse myelopathy leading to asymmetric paraparesis, with greater involvement of the right lower limb, presented after a fall on her previously operated left hip. She underwent THA 2 years earlier. Radiological evaluation revealed a transverse acetabular fracture with medial cup migration and an associated Vancouver AG fracture. Given the patient's reliance on the left limb for mobility and the risks of instability from multiple surgical approaches, the revision was performed through an extensile DAA. An antiprotrusio cage specifically designed for anterior implantation was used, and the femoral component was preserved. Early mobilization was initiated postoperatively, with the patient regaining pre-injury mobility within 6 months.

Conclusion: This case demonstrates the feasibility and benefits of using the extensile DAA in managing complex acetabular defects with a Burch-Schneider antiprotrusio cage. It highlights a surgical strategy that may reduce the risk of instability and improve functional outcomes in selected patients. The originality of this case lies in the use of an anterior approach to address a complication with a reconstruction technique typically reserved for posterior approaches. This report contributes to expanding the surgical options in revision hip arthroplasty and provides new insights into optimizing care in patients with complex anatomical and functional constraints.

Keywords: Hip; acetabular fracture; antiprotrusio cage; extensile direct anterior approach; prosthesis; revision.

Figure 1

Pre-operative pelvis antero-posterior X-ray.

Figure 2

Pre-operative pelvis computed tomography scan.

Figure 3

Six months post-operative pelvis antero-posterior X-ray.

Figure 4

Six months post-operative axial hip X-ray.