The direct anterior approach for acetabular augmentation in primary total hip arthroplasty

Abstract

Addressing acetabular bone defects can be difficult and depends on the amount of bone loss. Augments, either with bone or highly porous metals, are options that still allow the use of a hemispherical cup. Almost all previous research and publication on acetabular augments have focused on revision hip arthroplasty utilizing either a modified lateral or a posterolateral surgical approach. We describe 3 cases of augmenting acetabular bone defects through a direct anterior approach for primary total hip arthroplasty. We achieved proper cup placement, alignment, and augment incorporation while reconstructing complex acetabular deficiencies. All patients had complete pain relief and a satisfactory clinical outcome with stable radiographs at follow-up. With appropriate training, acetabular augmentation can be performed safely and efficiently with excellent clinical results through this approach.

Direct Anterior Cup-Half Cage for Revision and Complex Primary Total Hip Arthroplasty: Surgical Technique

“…Other data on the extensile DAA in the revision setting have been limited to case studies and reports. Honcharuk et al described the use of the extensile DAA in 3 patients who required acetabular augmentation for lateral rim defects [15]. Ramsey et al described the use of the DAA on one patient who required a custom triflange component in the setting of PD [16].…”

Triflange acetabular reconstruction for pelvic discontinuity through a direct anterior approach

“…Recent reports have described similar extensile anterior hip approach techniques for revision surgery [14], [15], which includes a recent series by Spanyer et al. [48] describing the added benefit of being able to place an anterior column plate on the internal ilium.…”

“…Honcharuk et al. [15] demonstrated the use of acetabular augmentation for lateral rim defects through an anterior hip approach for complex revision THA. Similar to Manrique et al.…”

“…Performing revision THA through varying surgical approaches, such as the posterior, modified Hardinge, and modified Watson Jones, has been well described in the literature [5], [6], [7]. Although the direct anterior approach (DAA) through the Smith-Petersen interval has gained popularity over the past 15 years [8], [9], [10], [11], few studies have evaluated its efficacy in revision arthroplasty [12], [13], [14], [15]. This can be attributed to the fact that DAA has been marketed and shown to be a minimally invasive approach by sparing soft-tissue trauma and muscle inflammation [16], [17], [18].…”