Modular Splined Tapered Stems Through the Direct Anterior Approach: Should I Make an Accessory Incision?

Area of Science:

• Orthopaedic Surgery
• Arthroplasty
• Revision Hip Surgery

Background:

• Femoral preparation via a proximal accessory incision (PAI) is proposed for modular splined tapered stems (STSs) in revision direct anterior (DA) total hip arthroplasty.
• Previous outcomes data for PAIs in this context are lacking.

Purpose of the Study:

• To compare outcomes of femoral revisions using a PAI versus traditional Heuter interval preparation.
• To evaluate differences in survivorship, complications, and patient-reported outcomes.

Main Methods:

• Retrospective review of 36 DA total hip arthroplasties using STS revision stems.
• Comparison between hips with PAI (n=16) and those prepared solely through the Heuter interval (n=20).
• Data collected on rerevisions, major complications, and Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) scores.

Main Results:

• Revision-free survivorship was 94% (PAI group) vs. 75% (Heuter group) (P=0.2).
• Major complications occurred in 6% (PAI group) vs. 30% (Heuter group) (P=0.1), including dislocation (PAI), and infection, fracture (Heuter).
• Mean HOOS JR scores were similar: 91.3 (PAI) vs. 92.6 (Heuter) (P=0.84).

Conclusions:

• The PAI approach is safe and effective for inserting modular STSs during DA femoral revisions.
• PAI may facilitate improved in-line reaming and reduce femoral elevation, potentially minimizing extensive exposures.
• A trend towards fewer major complications was observed with the PAI, warranting further investigation.