Posterior versus direct anterior approach in revision hip arthroplasty using Kerboull-type plate.

Tomonori Baba,Sammy Banno,Yuta Jinnai,Yasuhiro Homma,Taiji Watari,Kazuo Kaneko,Hiroki Tanabe

doi:10.1051/sicotj/2019040

Abstract

Introduction: The purpose of this study was to investigate revision with a Kerboull-type plate through the posterior approach (PA) and direct anterior approach (DAA) and compare the clinical outcome.Subjects and methods: Fifty-four patients (56 hip joints) underwent revision surgery in which acetabular reconstruction was performed concomitantly using the Kerboull-type plate and allogeneic bone. Revision surgery through DAA was performed in 21 hip joints and these were compared with 34 hip joints treated through PA. There was no significant difference in the patient demographics between the DAA and PA.Results: There was no significant difference between the operative times in the DAA and PA groups (203.2 ± 43.5 and 211.7 ± 41.8 min). There was a significant difference between the intraoperative blood loss in the DAA and PA groups (503.9 ± 223.7 mL and 703.8 ± 329.6 mL, respectively, p < 0.05). There was no significant difference between the modified Harris Hip Score in the DAA and the PA groups. The loosening of the acetabular component was observed in four cases (11.8%) in the PA group. In the DAA and PA groups, the 5-year survival rates were 100 and 85.7%, respectively. Recurrent dislocation of the hip was observed in six cases (one case in the DAA group (4.8%) and five cases in the PA group (14.7%)).Conclusions: It was verified that the difference in the surgical approach of acetabular reconstruction concomitantly using the Kerboull-type plate and allogeneic bone graft influenced the postoperative outcome.

Highlights

When loosening of the acetabular component occurs after total hip arthroplasty, revision surgery of the acetabular side is necessary, but it is technically difficult compared with normal total hip arthroplasty
The following options are available for acetabular revision surgery: 1) surgery with an acetabular component alone, 2) placement of an acetabular component with bone graft, and 3) acetabular reconstruction concomitantly using bone graft and a reinforcement device followed by placement of an acetabular component [1,2,3,4,5,6]
After January 2012, revision surgery through direct anterior approach (DAA) was performed in 22 hip joints and these were compared with 34 hip joints treated through the posterior approach (PA)

Summary

Introduction

When loosening of the acetabular component occurs after total hip arthroplasty, revision surgery of the acetabular side is necessary, but it is technically difficult compared with normal total hip arthroplasty. The following options are available for acetabular revision surgery: 1) surgery with an acetabular component alone, 2) placement of an acetabular component with bone graft, and 3) acetabular reconstruction concomitantly using bone graft and a reinforcement device followed by placement of an acetabular component [1,2,3,4,5,6]. We employ massive bone graft using allogeneic femoral head and a cross plate (Kerboull-type plate) as a reinforcement device because acquisition of recovery of bone stock and a favorable long-term survival rate by this reconstruction method has been demonstrated [5,6,7,8]. Since soft tissue can be conserved in DAA, recovery after surgery is fast; it is considered associated with a low dislocation rate and reduction of postoperative pain, and a favorable postoperative outcome can be expected [12, 13].

Objectives

Methods

Results

Conclusion