title: The Direct Anterior Approach for Complex Primary Total Hip Arthroplasty: The Extensile Acetabular Approach on a Regular Operating Room Table.
abstract: The direct anterior approach on a regular operating room table has been reported with low dislocation rates. This might be beneficial for complex primary total hip arthroplasty (THA) such as in patients with cerebral palsy or following femoral or pelvic osteotomies. Extending the approach is often required to overcome problems such as acetabular deformities or severe contractures.
  
  
  
  We retrospectively evaluated the results and complications of 29 patients with 37 complex primary THA in which an extensile approach was used. The extensile approach is described. Functional scores were collected in case the patient was ambulatory independently (n = 17).
  
  
  
  The average age was 35 years (range 15-85) with a mean follow-up of 39 months (range 12-60). There were 3 (8%) intra-operative and 4 (11%) early post-operative complications (<3 months), of which 3 (8%) were anterior dislocations. Late complications (>3 months) consisted of a fibrous ingrown stem, a socket loosening following a pelvic fracture, and a late hematogenous infection (8%). Seventy-one percent of the complications occurred in the first 18 cases (49%) indicating a learning curve. The mean post-operative Harris Hip Score was 79 (range 56-97).
  
  
  
  Complex THA can be safely conducted through the extensile anterior approach on a regular operating room table with the use of conventional implants, even in cases with a high risk of dislocation.
authors.affiliation: Department of Orthopaedic Surgery, University Hospitals Leuven-Pellenberg, Leuven, Belgium; Department of Orthopaedic Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Ben
authors.initials: B
authors.lastname: Molenaers
authors.affiliation: Department of Orthopaedic Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Ronald
authors.initials: R
authors.lastname: Driesen
authors.affiliation: Department of Orthopaedic Surgery, University Hospitals Leuven-Pellenberg, Leuven, Belgium.
authors.forename: Guy
authors.initials: G
authors.lastname: Molenaers
authors.affiliation: Department of Orthopaedic Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Kristoff
authors.initials: K
authors.lastname: Corten
mesh_terms: D000077:Acetabulum / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D058638:Operating Tables; D012189:Retrospective Studies; D055815:Young Adult
keywords: THA; cerebral palsy; developmental dysplasia; direct anterior approach; regular OR table