THP REVISION USING ANTERIEUR APPROACH IN LATERAL POSITION: PROSPECTIVE FEASIBILITY EVALUATION

Abstract

Anterior approaches have been suggested for THP revision in order to reduce dislocation rate. However, the exposure is considered to be more strenuous. The goal of the study was to evaluate if anterior approach in lateral position may improve the exposure.

From 2005 to 2007, 47 patients underwent THP revision, 34 times on the acetabular side, 2 times on the femoral side and 11 patients had a bipolar revision. Mean age was 64 years and mean BMI was 23. Patients were positioned on the lateral side and had an antero-lateral approach. During the femoral procedure, the leg was placed in a sterile bag stuck on the lateral side in order to optimize the exposure by positioning the femur in adduction and posterior translation.

Acetabular and femoral exposures were achieved correctly in all the cases allowing to perform all the revisions using this technique and no additional approach was needed in any patient. Antero-posterior femorotomies were performed in 7 patients for stem replacement and cement extraction, without any specific complication. Early post-operative anterior dislocations occurred in 2 patients who underwent monopolar cup revision. Dislocation was explained by an excessive anteversion of the remaining stems. 2 patients had an incomplete and transitory sciatic deficiency due to excessive posterior translation of the femoral head in the sciatic notch.

Using this technique, THP revision seems to be achievable even in complicated cases requiring stem revision and femorotomy. Dislocation rate was low; however a larger cohort is needed to confirm these preliminary results.