[Minimally invasive direct anterior approach for revision total hip arthroplasty]

Choice of the appropriate surgical exposure is an essential for visualization, extraction of old components and for the achievement of a stable and properly aligned construct at the end of the revision surgery. Controlled exposure reduces time of the procedure, minimizes blood loss and bone and soft-tissue damage. Authors introduced MIS direct anterior approach for primary total hip arthroplasty in 2006 year which resulted in necessary revision surgeries in 6 from 37 patients because of component misalignment and recurrent hip dislocation. In two cases only one prosthesis component had to be exchanged and in following four cases prosthesis cup and stem were revised. In 3 procedure was performed via the same surgical approach. In two cases authors performed proximal and distal enlargement of previous MIS approach. In one case revision surgery was performed with separate anterolateral approach. In all revised patients stable and congruent hip prosthesis construct was achieved. Authors did not observed any vascular or nerve lesion. No significant muscle damage was caused by incision enlargement. Revision hip arthroplasty can be performed with use of existing minimally invasive direct anterior approach. In revision cases with intensive femoral bone loss, after MIS direct anterior approach, separate lateral approach should be introduced. Increased risk of complications can be expected during learning phase of new MIS direct anterior approach.