Conversion hip arthroplasty via the direct anterior approach: pearls, pitfalls and personal experience.

Abstract

Conversion total hip arthroplasty (CTHA) through adirect anterior approach (DAA) in supine position. Failed osteosynthesis of proximal femoral fractures or failed conservative hip surgery, with hardware in situ. Decayed general conditions, infection (peri-implant or systemic infection), need for greater trochanter reconstruction, severe proximal femur deformity. Supine position. Mark DAA and expected limited incisions for hardware removal (HR) with the help of aC-arm. Use guidewire and extraction devices for HR. Perform aDAA with particular attention to awide release of the femur. Full progressive weight-bearing starting on day1, depending on bone quality. Discharge with crutches following patient walking capability. Precautions for 6weeks. In all, 27conversion THAs through aDAA. Mean age at the time of surgery59.8 (range 18-81) years. Mean body mass index was23.5 (range 17-31.6). Reasons of previous surgery failures were avascular necrosis of the femoral head, posttraumatic arthritis and nonunion with or without hardware migration. Mean surgical time was 125.8 min (range 58-190 min, standard deviation [SD]38.2 min). Mean follow-up time was 6.9years (range 2-15, SD 5.03years). Mean pre-Harris Hip Score (mHHs) was24.4 (range 19-36, SD 5.4), while the mean post-mHHS was90.3 (range 89-91, SD 0.95). Two patients required postoperative osteosynthesis for periprosthetic fractures due to falls. Overall complication rate was 10%.