{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T06:05:44Z","timestamp":1784786744246,"version":"3.55.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This report describes the surgical strategy and early clinical outcomes of a combined posterolateral approach (PLA) and direct anterior approach (DAA) for the management of osteonecrosis of the femoral head (ONFH) associated with a rare, massive encapsulating osteophyte.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      We present the case of a 51-year-old male with bilateral ONFH and a 10-cm massive heterotopic osteophyte of the right hip. The lesion induced a severe mechanical incarceration effect, rendering safe surgical exposure via a single conventional approach exceedingly challenging. A dual-incision strategy combining PLA and DAA was therefore implemented, which allowed for safe osteophyte resection under direct visualization,\n                      <jats:italic>in situ<\/jats:italic>\n                      femoral neck osteotomy, and precise prosthetic implantation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome<\/jats:title>\n                    <jats:p>The procedure was completed uneventfully, with effective preservation of the femoral nerve anteriorly and the sciatic nerve posteriorly. At the 3-month postoperative follow-up, the patient's right hip pain had resolved completely, joint range of motion (ROM) was markedly improved, and the Harris hip score (HHS) increased from 50 to 98. Objective functional tests demonstrated a full return of normal gait and a significant improvement in the Timed Up and Go (TUG) test from 18 s preoperatively to 8.5 s postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>For complex total hip arthroplasty (THA) involving severe anatomical distortion, a dual-incision strategy combining PLA and DAA enables safe surgery under 360\u00b0direct visualization. This approach serves as an effective salvage technique that reduces the risk of neurovascular injury.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1861763","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T05:38:15Z","timestamp":1784785095000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Combined posterolateral and direct anterior approaches for total hip arthroplasty in osteonecrosis of the femoral head with a rare massive osteophyte with literature review"],"prefix":"10.3389","volume":"13","author":[{"given":"Ruowen","family":"Yu","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shihao","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daojian","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"S112","DOI":"10.1016\/j.arth.2025.06.002","article-title":"Epidemiology, management, and systematic review of surgical trends for patients who have osteonecrosis of the femoral head","volume":"40","author":"Buddhiraju","year":"2025","journal-title":"J Arthroplasty"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1473","DOI":"10.1056\/NEJM199205283262206","article-title":"Nontraumatic necrosis of bone (osteonecrosis)","volume":"326","author":"Desforges","year":"1992","journal-title":"N Engl J Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.ejrad.2007.03.019","article-title":"Osteonecrosis of the femoral head: etiology, imaging and treatment","volume":"63","author":"Malizos","year":"2007","journal-title":"Eur J Radiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1508","DOI":"10.1016\/S0140-6736(07)60457-7","article-title":"The operation of the century: total hip replacement","volume":"370","author":"Learmonth","year":"2007","journal-title":"Lancet"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2773","DOI":"10.1007\/s00590-023-03528-8","article-title":"Comparing direct anterior approach versus posterior approach or lateral approach in total hip arthroplasty: a systematic review and meta-analysis","volume":"33","author":"Ang","year":"2023","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1016\/j.jor.2020.05.008","article-title":"Comparison of intra and post-operative complication rates among surgical approaches in total hip arthroplasty: a systematic review and meta-analysis","volume":"20","author":"Docter","year":"2020","journal-title":"J Orthop"},{"key":"B7","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1186\/s12891-016-1322-2","article-title":"The design of a randomised controlled trial to evaluate the (cost-) effectiveness of the posterolateral versus the direct anterior approach for THA (POLADA - 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