Call Catherine M, Mackenzie Johanna, Walsh Zoë A, Shevenell Bailey, Babikian George, McGrory Brian J, Rana Adam J
Tufts University School of Medicine, Boston, MA, USA.
MMP Orthopedics & Sports Medicine, Maine Medical Center, Portland, ME, USA.
Arthroplast Today. 2025 Jun 4;33:101731. doi: 10.1016/j.artd.2025.101731. eCollection 2025 Jun.
Total hip arthroplasty (THA) after prior hip or acetabular fracture fixation is considered higher risk than primary THA, as studies have shown reduced implant survival and higher infection rates. The anterior-based muscle-sparing (ABMS) approach can potentially reduce some of these risks by utilizing a new surgical interval. The goal of this study is to analyze the efficacy of the ABMS approach for conversion to hip arthroplasty surgery after previous fracture fixation with comparison to posterior approach.
This retrospective cohort study included patients with prior hip surgical intervention requiring hardware then converted to a THA using the ABMS or posterior approach at 1 institution between 2013 and 2020. Outcomes studied included postoperative complications, 30-day emergency department visits, 90-day readmission rates, any reoperation and patient-reported outcome measures.
A total of 85 patients (51 male and 34 female) in the ABMS group and 17 patients (9 male and 8 female) in the posterior group were included. Within the ABMS group, the mean age was 65.6 years (±16.2) with a mean body mass index of 27.5 kg/m (±5.4). The average operative time was 85 minutes (±35) and estimated blood loss was 178 mL (±183). There was 1 postoperative complication (dislocation) within 90 days, 1 patient made an emergency department visit within 30 days, and there were 3 readmissions within 90 days; only 1 readmission was orthopaedic in nature. One patient required reoperation (1.2%) over the study period of 5.0 years (±2.1). Patient-reported outcome measures indicate successful return of function. Operative, hospital, and outcome data were similar between patients receiving the ABMS and posterior approach.
This study is the first to evaluate outcomes of conversion THA using the ABMS approach, when compared to the posterior approach. Our institution's experience demonstrates that the ABMS approach is safe and effective for conversion THA after prior fracture fixation.
既往有髋关节或髋臼骨折内固定史后行全髋关节置换术（THA）被认为比初次THA风险更高，因为研究表明植入物生存率降低且感染率更高。基于前方的肌肉保留（ABMS）入路通过利用新的手术间隙可能会降低其中一些风险。本研究的目的是分析ABMS入路在既往骨折内固定后转换为髋关节置换手术的疗效，并与后方入路进行比较。
这项回顾性队列研究纳入了2013年至2020年期间在1家机构接受过髋关节手术干预且需要取出内固定物，随后采用ABMS或后方入路转换为THA的患者。研究的结果包括术后并发症、30天内急诊就诊情况、90天再入院率、任何再次手术以及患者报告的结局指标。
ABMS组共纳入85例患者（51例男性和34例女性），后方组纳入17例患者（9例男性和8例女性）。在ABMS组中,平均年龄为65.6岁（±16.2），平均体重指数为27.5kg/m²（±5.4）。平均手术时间为85分钟（±35），估计失血量为178mL（±18）。90天内有1例术后并发症（脱位），1例患者在30天内前往急诊就诊，90天内有3例再入院；只有1例再入院本质上是骨科相关的。在5.0年（±2.1）的研究期间，1例患者需要再次手术（1.2%）。患者报告的结局指标表明功能成功恢复。接受ABMS和后方入路的患者之间的手术、住院和结局数据相似。
本研究是首个评估与后方入路相比，采用ABMS入路进行THA转换手术结局情况的研究。我们机构的经验表明，ABMS入路在既往骨折内固定后进行THA转换手术时是安全有效的。
