Total hip arthroplasty using a combined anterior and posterior approach via a lateral incision in patients with ankylosed hips

• Published in: Canadian Journal of Surgery 2013-10, Vol.56 (5), p.332-340
• Main Authors: Li, Jian, MD, Wang, Zhiwei, MD, Li, Ming, MD, Wu, Yuesong, MS, Xu, Weidong, MD, Wang, Zimin, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Ankylosis; Ankylosis - diagnostic imaging; Ankylosis - surgery; Arthroplasty, Replacement, Hip - methods; Blood Loss, Surgical; Care and treatment; Female; Femur Neck - surgery; Hip joint; Hip Joint - diagnostic imaging; Hip Joint - pathology; Humans; Joint surgery; Male; Middle Aged; Osteotomy - methods; Postoperative Care; Radiography; Studies; Surgery; Surgical outcomes; Surgical techniques; Young Adult
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1503/cjs.000812

Background For most patients with severely ankylosed hips, traditional surgical approaches do not provide sufficient exposure during THAs. We report our experience with a combined anterior and posterior approach using a lateral incision for total hip arthroplasty (THA) in patients with severe, spontaneous bony hip ankylosis. Methods Between January 2004 and December 2008, patients with severe, spontaneous bony hip ankylosis underwent THA via a combined anterior and posterior approach using a lateral incision. Results We included 47 patients (76 hips) with a mean age of 53 (range 22–72) years in our study. All surgeries were successful, and no significant postoperative complications occurred. The mean operative duration was 1.5 (range 1.3–1.7) hours, and mean blood loss was 490 (range 450–580) mL. The mean duration of follow-up was 5.5 (range 2–11) years. Harris hip score improved from 53 to 88 points postoperatively, and the outcome was good to excellent in 88.37% of cases. Heterotopic ossification occurred in 6 hips, and infection, which resolved with antibiotics, occurred in 1 patient. Conclusion This combined anterior and posterior approach to THA using a lateral incision in patients with severe, spontaneous ankylosis provides very good exposure, protects the abduction unit and results in good to excellent postoperative recovery.