Abstract
Purpose
Conversion of a fused hip to a total hip arthroplasty (THA) is technically challenging due to the loss of anatomical references. Here, a reproducible technique using the direct anterior approach (DAA) with a regular surgical table under fluoroscopic guidance is described, which has several advantages over traditional such as lateral or posterior approaches.
Methods
There were reported 11 cases of ankylosis hip that were converted to THA using the same surgical technique protocol. Clinical and radiographic outcomes were recorded at 3.2 years of follow-up. A detailed preoperative evaluation was performed, including a pelvis radiological evaluation and magnetic resonance image (MRI) to assess the integrity of the periarticular soft tissue and flexor muscles.
Results
The DAA has considerable advantages, such as allowing more precise targeting during surgery, avoiding the risk of pseudoarthrosis due to the absence of a trochanteric osteotomy, preserving the abductors, and allowing an easier-to-use of intraoperative fluoroscopy due to the supine position. Besides, the use of a standard table reduces surgical time and allows assessment of limb length, hip stability, and impingement in all planes in an intraoperative dynamic range, which decreases postoperative complications.
Conclusion
Conversion from hip fusion to THA is a rare and complex procedure. The use of DAA with a standard table and fluoroscopy helps to avoid high complications since it allows a dynamic intra-operative examination of the range of motion to rule out impingements, reduces the risk of dislocation, and allows leg lengthening verification.
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Data availability
Not applicable. This manuscript describes a surgical procedure, and no data is processed.
Code availability
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References
Scemama C, Lestrat V, Combourieu B et al (2016) Anterior approach for total hip arthroplasty conversion of hip fusion. Int Orthop 40(9):1821–1825
Tamaki T, Oinuma K, Miura Y et al (2015) Total hip arthroplasty through a direct anterior approach for fused hips. Hip Int 25(6):549–552
Ji W, Stewart N (2016) Fluoroscopy assessment during anterior minimally invasive hip replacement is more accurate than with the posterior approach. Int Orthop 40(1):21–27
Jain S, Giannoudis PV (2013) Arthrodesis of the hip and conversion to total hip arthroplasty: a systematic review. J Arthroplasty 28(9):1596–1602
Villanueva M, Sobrón FB, Parra J et al (2013) Conversion of arthrodesis to total hip arthroplasty: clinical outcome, complications, and prognostic factors of 21 consecutive cases. HSS J 9(2):138–144
Rutz E, Schäfer D, Valderrabano V (2009) Total hip arthroplasty after hip joint ankylosis. J Orthop Sci 14(6):727–731
McNabb DC, Jennings JM, Levy DL et al (2017) Direct anterior hip replacement does not pose undue radiation exposure risk to the patient or surgeon. J Bone Joint Surg Am 99(23):2020–2025
Post ZD, Orozco F, Diaz-Ledezma C et al (2014) Direct anterior approach for total hip arthroplasty: indications, technique, and results. J Am Acad Orthop Surg 22(9):595–603
York PJ, Smarck CT, Judet T et al (2016) Total hip arthroplasty via the anterior approach: tips and tricks for primary and revision surgery. Int Orthop 40(10):2041–2048
Lustig S, Vaz G, Guyen O et al (2007) Désarthrodèse-prothèse de hanche pour séquelle d’arthrite septique: à propos d’une série de 17 cas à 6 ans de recul. Rev Chir Orthop Reparatrice Appar Mot 93(8):828–835. https://doi.org/10.1016/S0035-1040(07)78466-0
Richards CJ, Duncan CP (2011) Conversion of hip arthrodesis to total hip arthroplasty: survivorship and clinical outcome. J Arthroplasty 26(3):409–413
Sarraj M, Chen A, Ekhtiari S et al (2020) Traction table versus standard table total hip arthroplasty through the direct anterior approach: a systematic review. Hip Int 30(6):662–672
Nelson SJ and Rubin LE (2018) International Congress for Joint Reconstruction. ICJR REWIND: what are the top considerations for the table used in a DAA THA? Published on ICJR.net, February 5, 2018, and Re-Published January 29, 2019. https://icjr.net/articles/icjr-rewind-what-are-the-top-considerations-for-the-table-used-in-a-daa-tha Accessed 16 Nov 2020
Acknowledgements
The authors thank the surgical team of the Orthopaedics Surgery Department, Vall d’Hebron University Hospital, Barcelona.
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Martin Sierra, Iñaki Mimendia, and Víctor Barro. The first draft of the manuscript was written by Iñaki Mimendia and Andrés Aliaga-Martínez, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Mimendia, I., Barro, V., Sierra, M. et al. Fused hip conversion to total hip arthroplasty with the direct anterior approach: surgical technique on a regular surgical table under fluoroscopic guidance. International Orthopaedics (SICOT) 48, 1165–1170 (2024). https://doi.org/10.1007/s00264-024-06131-6
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DOI: https://doi.org/10.1007/s00264-024-06131-6