{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T03:33:07Z","timestamp":1792899187514,"version":"4.5.0"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T00:00:00Z","timestamp":1653955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T00:00:00Z","timestamp":1653955200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Innsbruck and Medical University of Innsbruck"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Oper Orthop Traumatol"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>The advantages of the direct anterior approach (DAA) in primary total hip arthroplasty as a\u00a0minimally invasive, muscle-sparing, internervous approach are reported by many authors. Therefore, the DAA has become increasingly popular for primary total hip arthroplasty (THA) in recent years, and the number of surgeons using the DAA is steadily increasing. Thus, the question arises whether femoral revisions are possible through the same interval.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Indications<\/jats:title>\n                <jats:p>Aseptic, septic femoral implant loosening, malalignment, periprosthetic joint infection or periprosthetic femoral fracture.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Contraindications<\/jats:title>\n                <jats:p>A\u00a0draining sinus from another approach.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Surgical technique<\/jats:title>\n                <jats:p>The incision for the primary DAA can be extended distally and proximally. If necessary, two releases can be performed to allow better exposure of the proximal femur. The DAA interval can be extended to the level of the anterior superior iliac spine (ASIS) in order to perform a\u00a0tensor release. If needed, a\u00a0release of the external rotators can be performed in addition. If a\u00a0component cannot be explanted endofemorally, and a\u00a0Wagner transfemoral osteotomy or an extended trochanteric osteotomy has to be performed, the skin incision needs to be extended distally to maintain access to the femoral diaphysis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Postoperative management<\/jats:title>\n                <jats:p>Depending on the indication for the femoral revision, ranging from partial weight bearing in cases of periprosthetic fractures to full weight bearing in cases of aseptic loosening.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>In all, 50\u00a0femoral revisions with a\u00a0mean age of 65.7\u00a0years and a\u00a0mean follow-up of 2.1\u00a0years were investigated. The femoral revision was endofemoral in 41\u00a0cases, while a\u00a0transfemoral approach with a\u00a0lazy\u2011S extension was performed in 9\u00a0patients. The overall complication rate was 12% (6\u00a0complications); 3\u00a0patients or 6% of the included patients required reoperations. None of the implanted stems showed a\u00a0varus or valgus position. There were no cases of mechanical loosening, stem fracture or subsidence. Median WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score before surgery improved significantly from preoperative (52.5) to postoperative (27.2).<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00064-022-00768-5","type":"journal-article","created":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T20:02:50Z","timestamp":1654027370000},"page":"189-202","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Femoral revision with the direct anterior approach","Femurrevision \u00fcber den direkt anterioren Zugang"],"prefix":"10.1007","volume":"34","author":[{"given":"Martin","family":"Thaler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristoff","family":"Corten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Nogler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris Michael","family":"Holzapfel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Moskal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,5,31]]},"reference":[{"key":"768_CR1","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/j.arth.2016.07.003","volume":"32","author":"SG Ghijselings","year":"2017","unstructured":"Ghijselings\u00a0SG, Driesen\u00a0R, Simon\u00a0JP et\u00a0al (2017) Distal extension of the direct anterior approach to the hip: a cadaveric feasibility study. 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Arch Orthop Trauma Surg 139:121\u2013126","journal-title":"Arch Orthop Trauma Surg"},{"key":"768_CR4","doi-asserted-by":"publisher","first-page":"780","DOI":"10.2106\/00004623-200704000-00012","volume":"89","author":"S Kurtz","year":"2007","unstructured":"Kurtz\u00a0S, Ong\u00a0K, Lau\u00a0E et\u00a0al (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J\u00a0Bone Joint Surg Am 89:780\u2013785","journal-title":"J Bone Joint Surg Am"},{"key":"768_CR5","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/j.artd.2016.09.008","volume":"3","author":"JP Martinez-Cano","year":"2017","unstructured":"Martinez-Cano\u00a0JP, Herrera-Escobar\u00a0JP, Arango Gutierrez\u00a0AS et al (2017) Prospective quality of life assessment after hip and knee arthroplasty: short- and mid-term follow-up results. Arthroplast Today 3:125\u2013130","journal-title":"Arthroplast Today"},{"key":"768_CR6","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1016\/j.arth.2016.07.044","volume":"32","author":"MM Nogler","year":"2017","unstructured":"Nogler\u00a0MM, Thaler\u00a0MR (2017) The direct anterior approach for hip revision: accessing the entire femoral diaphysis without endangering the nerve supply. J\u00a0Arthroplasty 32:510\u2013514","journal-title":"J Arthroplasty"},{"key":"768_CR7","doi-asserted-by":"crossref","unstructured":"Thaler M, Dammerer D, Hechenberger F et al (2021) The anatomical course of the lateral femoral cutaneous nerve in relation to various skin incisions used for primary and revision total hip arthroplasty with the direct anterior approach. 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J\u00a0Arthroplasty 35:1339\u20131343","journal-title":"J Arthroplasty"},{"key":"768_CR10","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1007\/s00402-019-03317-1","volume":"140","author":"M Thaler","year":"2020","unstructured":"Thaler\u00a0M, Lechner\u00a0R, Dammerer\u00a0D et al (2020) The direct anterior approach: treating periprosthetic joint infection of the hip using two-stage revision arthroplasty. Arch Orthop Trauma Surg 140:255\u2013262","journal-title":"Arch Orthop Trauma Surg"},{"key":"768_CR11","doi-asserted-by":"publisher","first-page":"3421","DOI":"10.1016\/j.arth.2017.05.056","volume":"32","author":"HY Zhao","year":"2017","unstructured":"Zhao\u00a0HY, Kang\u00a0PD, Xia\u00a0YY et\u00a0al (2017) Comparison of Early Functional Recovery After Total Hip Arthroplasty Using a\u00a0Direct Anterior or Posterolateral Approach: A Randomized Controlled Trial. 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All studies mentioned were in accordance with the ethical standards indicated in each case.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}