Exposure for revision: total hip replacement.

Area of Science:

• Orthopedic Surgery
• Reconstructive Surgery
• Biomedical Engineering

Background:

• Revision total hip replacement (THR) is a complex procedure.
• Choosing the appropriate surgical approach is critical for successful outcomes.
• Various challenges exist in revision hip surgery, including implant removal and bone reconstruction.

Purpose of the Study:

• To describe four fundamental surgical approaches for revision total hip replacement (THR).
• To delineate the indications and key technical aspects of each approach.
• To provide guidance for managing complex femoral and acetabular reconstructions in THR.

Main Methods:

• Posterior approach: utilized for simple revisions, focusing on soft tissue release for femoral displacement.
• Sliding trochanteric osteotomy: employed for enhanced femoral and acetabular exposure, requiring precise osteotomy orientation.
• Extended trochanteric osteotomy: indicated for difficult femoral revisions, involving removal of the lateral femoral shaft.
• Combined AP extensile approach: reserved for complex acetabular reconstructions, potentially requiring surgical assistance.

Main Results:

• Each approach offers specific advantages for different revision scenarios.
• The posterior approach facilitates revisions of loose components and stems.
• Trochanteric osteotomies provide greater exposure for challenging implant removal and reconstruction.
• The AP extensile approach is crucial for extensive acetabular reconstruction.

Conclusions:

• The selection of the surgical approach is tailored to the specific challenges of the revision total hip replacement.
• Mastery of these four techniques enables surgeons to manage a wide spectrum of revision THRs effectively.
• Careful surgical technique and planning are essential to minimize complications and optimize functional recovery in revision hip surgery.