Head/Liner Exchange through the Direct Anterior Approach
Surgeons who have only performed primary total hip arthroplasty (THA) procedures through the direct anterior approach (DAA) but want to use the DAA for revision procedures often start with head/liner exchanges, as this is the easiest and quickest revision procedure to master.
At ICJR’s 4th Annual Anterior Hip Course, John L. Mason, MD, from OrthoCarolina in Charlotte, North Carolina, discussed his stepwise approach to exposure for head/liner exchanges with the DAA.
Dr. Mason had 6 takeaway messages for attendees at the session:
- Confirm that the stem is stable and osteointegrated on X-ray before the procedure – but be prepared to revise the stem if necessary once the site is exposed.
- Know the liner options that are available based on the type of cup that was used and when it was implanted.
- Know the inner diameter of the cup being revised in case the liner has to be cemented in if there are no viable options with modular liners.
- Ensure the needed revision instruments are ordered before surgery and available and ready to go the day of the procedure.
- Ignore the healed incision if the patient’s primary procedure was done through the posterior approach.
- Remember to move the leg position as needed to facilitate exposure of the site.
Click the image above to hear Dr. Masonis describe his approach for a head/liner exchange through the DAA.