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Minimally Invasive Direct Anterior Approach for Revision of the Acetabular Component

February 19, 2016

Contributors: Francesco Traina, MD, PhD; Daniele Fabbri, MD; Domenico Fenga, MD; Raffaele Borghi, MD; Fabrizio Perna; Eugenio Leo, MD; Carlotta Calamelli; Mohammadreza Chehrassan, MD; Cesare Faldini, MD; Cesare Faldini, MD

2016 AWARD WINNER In the past few years, the prevalence of revision total hip arthroplasty (THA) has substantially increased in direct proportion to the increasing number of patients who undergo primary THA. A review of the National Inpatient Sample Database found that isolated acetabular revision accounted for approximately two-thirds of patients who undergo revision THA. Revision THA can be performed via the posterior, modified Hardinge, and modified Watson-Jones approaches. The direct anterior approach through the Smith-Petersen interval has been increasing in popularity; however, few studies have described revision THA via this approach. The goal of this video is to describe surgical tips and pitfalls of acetabular cup revision via a modified, minimally invasive direct anterior approach. This approach is the only method for minimally invasive THA cup revision via an intermuscular plane without the detachment of muscle from bone. An incision is made 2 cm distal and 2 cm lateral to the anterior superior iliac spine in the direction of the lateral epicondyle of the distal femur and is extended for 6 cm to 8 cm to reach the anteromedial part of the tensor fasciae lata. The fascia is incised and detached superiorly and medially to access the intermuscular space without damaging the lateral femoral nerve. Dedicated instruments and an orthopaedic table are mandatory for correct acetabular exposure. The direct anterior approach affords good access to the acetabulum and allows for effective management of all acetabular bone defects. In addition, the approach allows for cup revision with low blood loss and a quick recovery.

Results for "Revision Hip Arthroplasty"

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