The Extended Direct Anterior Approach for Column Augmentation in the Deficient Pelvis: A Novel Surgical Technique, and Case Series Report

Abstract Background Anterior column deficiency of the pelvis may pose a serious threat to the stability of the acetabular component after total hip arthroplasty, and thus jeopardize the overall success of the procedure. Methods After IRB approval, a retrospective review was undertaken to identify all patients undergoing revision THA with anterior column augmentation through an extended direct anterior approach. Demographics and surgical details were collected, and subjects were followed for a 2-year minimum period to measure patient outcomes and to evaluate for the stability of construct fixation. A novel surgical procedure description was provided and supplemented with an illustrative case example. Results At 2-years post augmentation, patients had favorable functional outcomes with radiologic evidence of stable fixation. Conclusion Proximal extension of the direct anterior approach to the hip can facilitate anterior column access and augmentation to improve stability of the hip reconstruction. This treatment may be an alternative to spanning constructs such as cup-cage constructs and custom implants, affording the potential for long-term biologic fixation. Further investigation into this technique is warranted.