Abstract
In recent years, the direct anterior approach (DAA) has become a standard approach for primary total hip arthroplasty (THA). With the increasing use of the DAA in primary cases also more and more revision surgeries are performed through the same interval. With ability to extend the DAA interval proximally and distally, loose cups, loose stems, and even periprosthetic femoral fractures (PPF) can be treated. Especially, PPF are devastating complications causing functional limitations and increased mortality. Therefore, we conducted a study to report the outcome of surgical treatment of PPF with the DAA interval.
We report on the one year complications and mortality in 40 cases with a mean clinical follow-up of 1.5 years. Mean age of patients was 74.3 years. Fractures were classified as Vancouver B2 (36), and B3 (N=4). In 14 cases, a standard stem was used, and in 26 cases a modular revision stem. In 30 cases, a distal extension +/- tensor release was used, in 4 cases a proximal tensor release was done, and in the remaining 6 cases revision could be performed without extension of the approach.
Median cut/suture time was 152 minutes (IQR 80 – 279). The overall complication rate in our patient group was 12.5%. 2 patients died in the first three months after operation. One patient had a transient femoral nerve palsy, which completely recovered.
The DAA interval to the hip for the treatment of PFF showed similar results compared with other approaches regarding mortality, complications, fracture healing, dislocation rate and clinical results. We conclude that femoral revision in case of PPF in the DAA interval is a safe and reliable procedure. Each Vancouver type of periprosthetic fracture can be treated by use of this approach.
