Witt Austin N, Gladnick Brian P, Bhimani Aamir A, Gililland Jeremy M, Anderson Lucas A
Department of Orthopaedic Surgery, Baylor Univeristy Medical Center, Dallas, Texas.
W.B. Carrell Memorial Clinic, Adult Hip and Knee Reconstruction, Dallas, Texas.
J Arthroplasty. 2025 Sep;40(9S1):S394-S399. doi: 10.1016/j.arth.2025.05.084. Epub 2025 May 27.
Femoral preparation through a proximal accessory incision (PAI) has been suggested for placement of modular splined tapered stems (STSs) during revision direct anterior (DA) total hip arthroplasty. However, outcomes using PAIs have not been previously reported. The purpose of this study was to compare femoral revisions using a PAI with revisions in which all preparation was done through the Heuter interval, specifically looking for differences in: (1) survivorship, (2) complications, and (3) patient-reported outcomes.
There were 36 hips that underwent DA femoral reconstruction with an STS revision stem by one of three fellowship-trained arthroplasty specialists at two orthopaedic teaching hospitals. The mean follow-up was 2.4 years. Electronic medical records were reviewed to determine if a PAI was made, to record rerevisions or major complications, and to collect demographic data and Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement scores. Continuous variables were analyzed using Student's t-test; categorical variables were analyzed using Fisher's exact test.
A PAI was made in 16 hips (44%). In 20 hips (56%), all femoral preparation was done through the Heuter interval. Revision-free survivorship was found in 15 of 16 hips in the PAI group and 75% (15 of 20 hips) in the Heuter group (P = 0.2). A PAI hip sustained a major complication (dislocation; one of 16). Conversely, six hips (six of 20 hips, 30%) in the Heuter group suffered a major complication: three infections, one intraoperative femoral fracture, and two postoperative periprosthetic fractures (P = 0.1). Postoperative Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement scores were 91.3 (PAI) and 92.6 (Heuter; P = 0.84).
The PAI is safe and effective for insertion of a modular STS during DA femoral revisions, compared to all femoral preparation done through the Heuter interval. Improved in-line reaming and less femoral elevation required with the PAI may limit the necessity for larger extensile exposures and aggressive femoral releases. There was a trend toward fewer major complications in the PAI group; however, this did not reach statistical significance with the numbers available.
在翻修直接前路全髋关节置换术中，有人建议通过近端辅助切口（PAI）进行股骨准备以植入模块化花键锥形柄（STS）。然而，此前尚未报道使用PAI的结果。本研究的目的是比较使用PAI进行的股骨翻修与所有准备工作均通过霍伊特间隙完成的翻修，具体观察以下方面的差异：（1）生存率；（2）并发症；（3）患者报告的结局。
在两家骨科教学医院，由三位接受过专科培训的关节置换专科医生之一，对36例髋关节进行了DA股骨重建并使用STS翻修柄。平均随访时间为2.4年。查阅电子病历以确定是否进行了PAI，记录再次翻修或主要并发症，并收集人口统计学数据以及髋关节功能障碍和骨关节炎关节置换结局评分。连续变量采用学生t检验进行分析；分类变量采用Fisher精确检验进行分析。
16例髋关节（44%）进行了PAI。20例髋关节（56%）的所有股骨准备工作均通过霍伊特间隙完成。PAI组16例髋关节中有15例无翻修存活，霍伊特组20例髋关节中有75%（15例）无翻修存活（P = 0.2）。1例接受PAI的髋关节发生了主要并发症（脱位；16例中的1例）。相反，霍伊特组有6例髋关节（20例中的6例，30%）发生了主要并发症：3例感染、1例术中股骨骨折和2例术后假体周围骨折（P = 0.1）。术后髋关节功能障碍和骨关节炎关节置换结局评分分别为91.3（PAI）和92.6（霍伊特；P = 0.84）。
与所有股骨准备工作均通过霍伊特间隙完成相比，在DA股骨翻修术中，PAI用于植入模块化STS是安全有效的。PAI所需的改进的直线扩髓和较少的股骨抬高可能会减少更大范围扩展性暴露和积极股骨松解的必要性。PAI组的主要并发症有减少的趋势；然而，根据现有数据，这未达到统计学意义。
