Hip Department (CAD) Gaetano Pini-CTO Orthopedic Institute, University of Milan, P.za Cardinal Ferrari 1, 20122, Milano, Italy.
Department of Orthopedics and Trauma Surgery, Musculoskeletal University Centre Munich (MUM), University Hospital, LMU Munich, Munich, Germany.
Oper Orthop Traumatol. 2022 Jun;34(3):177-188. doi: 10.1007/s00064-022-00769-4. Epub 2022 May 17.
Conversion total hip arthroplasty (CTHA) through a direct 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 a C-arm. Use guidewire and extraction devices for HR. Perform a DAA with particular attention to a wide release of the femur.
Full progressive weight-bearing starting on day 1, depending on bone quality. Discharge with crutches following patient walking capability. Precautions for 6 weeks.
In all, 27 conversion THAs through a DAA. Mean age at the time of surgery 59.8 (range 18-81) years. Mean body mass index was 23.5 (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 6.9 years (range 2-15, SD 5.03 years). Mean pre-Harris Hip Score (mHHs) was 24.4 (range 19-36, SD 5.4), while the mean post-mHHS was 90.3 (range 89-91, SD 0.95). Two patients required postoperative osteosynthesis for periprosthetic fractures due to falls. Overall complication rate was 10%.
通过仰卧位直接前侧入路（DAA）进行全髋关节置换术（CTHA）。
股骨近端骨折内固定失败或保守性髋关节手术失败，内固定在位，伴有硬件。
一般情况恶化、感染（植入物周围或全身感染）、需要重建大转子、严重的股骨近端畸形。
仰卧位。在 C 臂的帮助下，标记 DAA 和预计用于硬件移除（HR）的有限切口。使用导丝和提取装置进行 HR。进行 DAA，特别注意股骨的广泛松解。
根据骨质量，术后第一天即可完全负重。患者具备行走能力后，用拐杖辅助离院。注意 6 周。
总共 27 例通过 DAA 进行了 CTHA。手术时的平均年龄为 59.8 岁（18-81 岁）。平均身体质量指数为 23.5（17-31.6）。先前手术失败的原因是股骨头缺血性坏死、创伤后关节炎和非愈合，伴有或不伴有硬件迁移。平均手术时间为 125.8 分钟（58-190 分钟，标准差[SD]38.2 分钟）。平均随访时间为 6.9 年（2-15 年，SD 5.03 年）。平均术前 Harris 髋关节评分（mHHs）为 24.4（19-36，SD 5.4），而平均术后 mHHS 为 90.3（89-91，SD 0.95）。由于跌倒，有 2 名患者需要进行术后假体周围骨折的内固定。总并发症发生率为 10%。
