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Related Experiment Video

Updated: Sep 20, 2025

Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
09:31

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

Austin N Witt1, Brian P Gladnick2, Aamir A Bhimani1

  • 1Department of Orthopaedic Surgery, Baylor Univeristy Medical Center, Dallas, Texas.

The Journal of Arthroplasty
|May 29, 2025
PubMed
Summary
This summary is machine-generated.

A proximal accessory incision (PAI) is safe for revision hip arthroplasty using splined tapered stems (STSs). This approach may reduce major complications compared to traditional methods, though further study is needed.

Keywords:
complicationsdirect anterior approachheuter intervalproximal accessory incisionrevision

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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.