gms | German Medical Science

Objectives: Aseptic acetabular loosening is one of the most common long-term complications of total hip replacement. Treatment of this complication involves an isolated replacement of the loosening cup. Preservation of a stable correctly oriented femoral component requires a careful choice of surgical approach to the hip joint due to the presence of a prominent neck stem which limiting access and visualization of the acetabulum.

The aim of the study was to reveal the optimal surgical approach to the hip joint for an isolated acetabular replacement.

Methods: We analyzed the results of surgical treatment of 126 patients with isolated aseptic acetabular loosening and stable correctly oriented stem, operated in the period from 2014 to 2016. The average age of the patients was 64 ± 4.6. The ratio of women and men is 78 (62%) and 48 (38%), respectively. The diagnosis was established on the basis of clinical and radiological data, intraoperatively. All patients underwent an isolated replacement of an unstable acetabular component and a pair of friction. A stable correctly oriented stem was preserved. All patients were divided into 2 groups depending on the surgical approach. 1st group included 72 patients were operated using posterolateral approach due to it had used during primary arthroplasty. 2nd group included 54 patients were operated by anterolateral approach. Surgery was performed under endotracheal anesthesia in combination with neuroleptanalgesia. All patients received standard treatment in the postoperative period. Clinical results after were evaluated using a Harris Hip Score (HHS) and a VAS scale after 1 year. Statistical processing of data was carried out using Microsoft Excel AtteStat 12.0.5.

Results: The posterior approach to the hip joint applied in 1st group showed insufficient visualization and limited access to the anterior wall of the acetabulum by prominent neck preserved stem. In order to preserved a stable stem and increase visibility, we cut off the middle gluteus muscle and used combined posterolateral and anterolateral approaches. The mean values of the Harris Hip Score in 1st group (82.3 points) were statistically different from the mean values in the 2nd group (88.6 points) (p <0.01). In the 1st group, the distribution of results was 34% (24 patients) excellent, 47% (34 patients) good, 19% (14 patients) satisfactory. In the 2nd group, the distribution of results was 49% (26) excellent, 38% (21) good, 13% (7) satisfactory. The mean value of the VAS scale in 1st group (3.97 points) was also statistically different from the mean values in 2nd group (1.24 points) (p <0.01).

Conclusions: Anterolateral surgical approach provides adequate visualization and access to the acetabulum, improves the results of treatment and can be recommended as optimal approach for treatment of isolated acetabular loosening.