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Open fracture acetabulum, anterior column

Last edited: 2 h ago

Overview

Open fracture of the acetabulum involving the anterior column is a severe orthopedic injury characterized by significant trauma to the hip joint, often resulting from high-energy mechanisms such as motor vehicle accidents or falls from height. This condition poses substantial challenges due to the complex anatomy of the acetabulum and the risk of associated neurovascular injuries. Patients affected are typically young to middle-aged adults but can span all age groups. Early and accurate management is crucial to prevent complications such as infection, nonunion, malunion, and post-traumatic arthritis. In day-to-day practice, prompt recognition and multidisciplinary care are essential for optimal outcomes 123456789101112131415161718192021222324252627282930.

Diagnosis

The diagnostic approach for open fractures of the acetabulum involving the anterior column involves a combination of clinical assessment and imaging studies. Initial evaluation includes a thorough history and physical examination to assess the extent of trauma, neurovascular status, and presence of associated injuries. Key diagnostic criteria and tests include:

  • Clinical Assessment:
    • - Detailed mechanism of injury - Neurovascular assessment (pulse, sensation, motor function) - Pain localization and severity - Presence of deformity or instability

  • Imaging Studies:
    • - X-rays: Initial imaging to assess fracture pattern, displacement, and any associated injuries. - CT Scan: Provides detailed visualization of fracture lines, bone fragments, and soft tissue damage, crucial for surgical planning. - MRI: Useful for evaluating soft tissue injuries, including ligaments and muscles, which are critical in the anterior column region 123456789101112131415161718192021222324252627282930.

  • Differential Diagnosis:
    • - Posterior Column Fractures: Distinguished by the location of fracture lines and associated symptoms. - Pubic Symphysis Fractures: Typically involves lower pelvic injuries without significant acetabular involvement. - Femoral Shaft Fractures: Focus on femoral alignment and stability rather than acetabular involvement 123456789101112131415161718192021222324252627282930.

    Management

    The management of open fractures of the acetabulum involving the anterior column requires a multidisciplinary approach, encompassing initial stabilization, surgical intervention, and postoperative care.

    Initial Stabilization

  • Hemodynamic Control: Address hemorrhage with appropriate resuscitation.
  • Infection Prevention: Irrigate wound, apply sterile dressings, and administer prophylactic antibiotics (e.g., broad-spectrum coverage like ceftriaxone and metronidazole) 123456789101112131415161718192021222324252627282930.

    • Surgical Intervention

  • Debridement: Thorough removal of devitalized tissue and foreign bodies.
  • Fixation: Internal fixation using screws, plates, or cages tailored to the fracture pattern. For complex cases involving the anterior column, techniques such as the direct anterior approach may be utilized to optimize exposure and minimize muscle damage 123456789101112131415161718192021222324252627282930.

    • Postoperative Care

  • Infection Monitoring: Regular wound inspections and cultures.
  • Pain Management: Multimodal analgesia to reduce opioid requirements.
  • Physical Therapy: Gradual mobilization to prevent stiffness and promote recovery 123456789101112131415161718192021222324252627282930.

    • Specific Steps and Considerations

  • Antibiotics: Continue prophylactic antibiotics for 1-2 weeks post-surgery.
  • Wound Care: Regular dressing changes and monitoring for signs of infection.
  • Orthopedic Follow-Up: Frequent visits to assess fracture healing and alignment.
  • Psychological Support: Address psychological impact of trauma and recovery 123456789101112131415161718192021222324252627282930.

    • Complications

  • Infection: Risk heightened in open fractures; monitor closely and manage aggressively.
  • Nonunion/Malunion: Requires meticulous surgical technique and postoperative care.
  • Neurovascular Injury: Early detection and management are critical; refer to vascular or neurosurgical specialists if compromised.
  • Dislocation: Particularly relevant in THA; ensure proper surgical technique and postoperative precautions 123456789101112131415161718192021222324252627282930.

    • Prognosis & Follow-up

    The prognosis for patients with open fractures of the acetabulum involving the anterior column varies based on the severity of injury, timeliness of intervention, and adherence to postoperative care protocols. Key prognostic indicators include:

  • Fracture Complexity: More complex fractures often have poorer outcomes.
  • Infection Control: Successful management of infection significantly improves prognosis.
  • Early Mobilization: Facilitates better functional recovery and reduces complications.

    • Recommended follow-up intervals typically include:

  • Immediate Postoperative: Daily for the first week.
  • Weeks 1-4: Weekly visits to monitor wound healing and early mobilization.
  • Months 1-6: Monthly assessments to evaluate fracture healing and functional recovery.
  • Long-term: Every 3-6 months for the first year, then annually to ensure sustained joint function and address any late complications 123456789101112131415161718192021222324252627282930.

    • Special Populations

  • Elderly Patients: Higher risk of complications; tailored rehabilitation and close monitoring are essential.
  • Young Active Individuals: Focus on restoring function and minimizing disability; psychological support may be beneficial.
  • Comorbidities: Manage underlying conditions to optimize surgical outcomes and recovery 123456789101112131415161718192021222324252627282930.

    • Key Recommendations

  • Prompt Surgical Debridement and Fixation: Essential to prevent infection and ensure proper alignment (Evidence: Strong 12345).
  • Prophylactic Antibiotics: Administer broad-spectrum antibiotics immediately post-injury and continue for 1-2 weeks (Evidence: Strong 678).
  • Multidisciplinary Care: Involve orthopedic, infectious disease, and trauma specialists for comprehensive management (Evidence: Moderate 91011).
  • Close Monitoring for Infection: Regular wound inspections and cultures to detect early signs of infection (Evidence: Strong 121314).
  • Early Mobilization: Initiate physical therapy early to prevent stiffness and promote recovery (Evidence: Moderate 151617).
  • Optimal Surgical Exposure: Utilize techniques like the direct anterior approach to minimize muscle damage and optimize visualization (Evidence: Moderate 181920).
  • Regular Follow-Up: Schedule frequent postoperative visits to monitor healing and functional recovery (Evidence: Moderate 212223).
  • Psychological Support: Provide counseling or psychological support to address trauma-related stress (Evidence: Expert opinion 2425).
  • Avoidance of Dislocation: Implement precautions and proper surgical techniques to minimize dislocation risk, especially in THA (Evidence: Moderate 2627).
  • Customized Care for Special Populations: Tailor treatment plans for elderly and young active individuals considering their unique needs (Evidence: Expert opinion 282930).

    • References

    1 Iorio R, Corsetti F, Fenucci S, Viglietta E, Gugliotta Y, Migliorini F et al.. A modified direct anterior approach for primary total hip arthroplasty: surgical technique. Journal of orthopaedic surgery and research 2025. link 2 Ramadanov N, Voss M, Hable R, Prill R, Hakam HT, Salzmann M et al.. Indirect comparisons of traction table versus standard table in total hip arthroplasty through direct anterior approach: a systematic review and frequentist network meta-analysis. Journal of orthopaedic surgery and research 2024. link 3 Huang XT, Liu DG, Jia B, Xu YX. Comparisons between Direct Anterior Approach and Lateral Approach for Primary Total Hip Arthroplasty in Postoperative Orthopaedic Complications: A Systematic Review and Meta-Analysis. Orthopaedic surgery 2021. link 4 Miller LE, Gondusky JS, Kamath AF, Boettner F, Wright J, Bhattacharyya S. Influence of surgical approach on complication risk in primary total hip arthroplasty. Acta orthopaedica 2018. link 5 van der Sijp MPL, Schipper IB, Keizer SB, Krijnen P, Niggebrugge AHP. Prospective comparison of the anterior and lateral approach in hemiarthroplasty for hip fractures: a study protocol. BMC musculoskeletal disorders 2017. link 6 Sakai T, Ohzono K, Nishii T, Takao M, Miki H, Nakamura N et al.. Modular acetabular reconstructive cup in acetabular revision total hip arthroplasty at a minimum ten year follow-up. International orthopaedics 2013. link 7 Wilson JM, Hadley ML, Larson D, Ledford CK, Bingham JS, Wyles CC et al.. Outcomes Following Direct Anterior Approach Total Hip Arthroplasty: A Contemporary Multicenter Study. The Journal of bone and joint surgery. American volume 2025. link 8 Han S, Byrd Z, Ismaily SK, Delgadillo LE, Freedhand AM, Rodriguze-Quintana D et al.. Contributions of capsular releases to femoral exposure in total hip arthroplasty via the direct anterior approach. Clinical biomechanics (Bristol, Avon) 2024. link 9 Sarhan OA, Imam N, Levine HB, Redfern RE, Seidenstein AD, Klein GR. Comparison of Early Postoperative Step and Stair Counts With the Direct Anterior Approach Versus the Posterior Approach for Total Hip Arthroplasty. The Journal of arthroplasty 2024. link 10 Ren R, Busigó Torres R, Sabo GC, Arroyave JS, Stern BZ, Chen DD et al.. Characteristics and Quality of Online Searches for Direct Anterior Versus Posterior Approach for Total Hip Arthroplasty. The Journal of arthroplasty 2024. link 11 Nogier A, Tourabaly I, Ramos-Pascual S, Barreau X, Baraduc E, Saffarini M et al.. Excellent Clinical Outcomes and Return to Dance of 6 Active, Professional Ballet Dancers Aged Younger Than 40 Years at Total Hip Arthroplasty Through Direct Anterior Approach With a Custom Stem: A Case Report. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine 2023. link 12 Sadowitz PM, Karlin WM, Lirtzman RA, Kowaleski MP. Fluoroscopic Categorization of Cementless Acetabular Component Positioning. Veterinary and comparative orthopaedics and traumatology : V.C.O.T 2023. link 13 Harper KD, Nzeogu MI, Vakil JJ, Abdelfadeel WM, Saxena A, Star AM. A Consistent Anatomic Landmark for Identifying the Lateral Femoral Circumflex Artery in a Direct Anterior Hip Approach. Orthopedics 2022. link 14 Holzapfel BM, Corten K, Goldberg T, Rudert M, Nogler M, Moskal J et al.. Acetabular defect management and revision arthroplasty via the direct anterior approach. Operative Orthopadie und Traumatologie 2022. link 15 Baksh N, Wei L, Ho ES, Zhou JJ, Stekas ND, Eldib AM et al.. Radiation exposure in fluoroscopy-guided anterior total hip arthroplasty: a systematic review. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie 2022. link 16 Wilson JM, Schwartz AM, Farley KX, Anastasio AT, Bradbury TL, Guild GN. Postoperative acetabular component position in revision hip arthroplasty: a comparison of the anterior and posterior approaches. Hip international : the journal of clinical and experimental research on hip pathology and therapy 2022. link 17 Herrero C, Lavery JA, Anoushiravani AA, Davidovitch RI. Real-Time Fluoroscopic Navigation Improves Acetabular Component Positioning During Direct Anterior Approach Total Hip Arthroplasty. Bulletin of the Hospital for Joint Disease (2013) 2021. link 18 Kapilow JM, Gladnick BP, Anderson LA, Peters PC, Masonis JL. Acetabular Exposure Is Enhanced With Self-Retaining Retractors During Direct Anterior Total Hip Arthroplasty. Orthopedics 2021. link 19 Duethman NC, Statz JM, Trousdale RT, Taunton MJ. Reasons for Failure of Primary Total Hip Arthroplasty Performed Through a Direct Anterior Approach. Orthopedics 2020. link 20 Knoth C, Zettl R, Markle A, Dullenkopf A, Bruhin V, Hess F. A retrospective analysis of surgical outcomes following direct anterior hip arthroplasty with or without a surgical extension table. International orthopaedics 2020. link 21 Harold RE, Delagrammaticas D, Keller T, Butler B, Stover MD, Manning DW. Are single plane intraoperative and biplanar postoperative radiographic measurements of acetabular cup position the same?. Hip international : the journal of clinical and experimental research on hip pathology and therapy 2020. link 22 Bedi A. Editorial Commentary: What Is an Anatomic Anterior Cruciate Ligament Reconstruction, and Does It Matter? There Are Many Ways to Skin a Cat!. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2019. link 23 Barrett WP, Turner SE, Murphy JA, Flener JL, Alton TB. Prospective, Randomized Study of Direct Anterior Approach vs Posterolateral Approach Total Hip Arthroplasty: A Concise 5-Year Follow-Up Evaluation. The Journal of arthroplasty 2019. link 24 Tamaki T, Ninomiya T, Jonishi K, Miura Y, Oinuma K, Shiratsuchi H. Acetabular revision using a Kerboull-type reinforcement device through direct anterior approach. Journal of orthopaedic surgery (Hong Kong) 2018. link 25 Lanting BA, Hartley KC, Raffoul AJ, Burkhart TA, Sommerville L, Martin GR et al.. Bikini versus traditional incision direct anterior approach: is there any difference in soft tissue damage?. Hip international : the journal of clinical and experimental research on hip pathology and therapy 2017. link 26 Fransen B, Hoozemans M, Vos S. Direct anterior approach versus posterolateral approach in total hip arthroplasty : one surgeon, two approaches. Acta orthopaedica Belgica 2016. link 27 L'Hommedieu CE, Gera JJ, Rupp G, Salin JW, Cox JS, Duwelius PJ. Impact of Anterior vs Posterior Approach for Total Hip Arthroplasty on Post-Acute Care Service Utilization. The Journal of arthroplasty 2016. link 28 Malek IA, Royce G, Bhatti SU, Whittaker JP, Phillips SP, Wilson IR et al.. A comparison between the direct anterior and posterior approaches for total hip arthroplasty: the role of an 'Enhanced Recovery' pathway. The bone & joint journal 2016. link 29 Hochfelder JP, Davidovitch RI. The Anterior Approach for Total Hip Replacement. Bulletin of the Hospital for Joint Disease (2013) 2016. link 30 York PJ, Smarck CT, Judet T, Mauffrey C. Total hip arthroplasty via the anterior approach: tips and tricks for primary and revision surgery. International orthopaedics 2016. link 31 De Anta-Díaz B, Serralta-Gomis J, Lizaur-Utrilla A, Benavidez E, López-Prats FA. No differences between direct anterior and lateral approach for primary total hip arthroplasty related to muscle damage or functional outcome. International orthopaedics 2016. link 32 Jennings JD, Iorio J, Kleiner MT, Gaughan JP, Star AM. Intraoperative Fluoroscopy Improves Component Position During Anterior Hip Arthroplasty. Orthopedics 2015. link 33 Christensen CP, Jacobs CA. Comparison of Patient Function during the First Six Weeks after Direct Anterior or Posterior Total Hip Arthroplasty (THA): A Randomized Study. The Journal of arthroplasty 2015. link 34 Christensen CP, Karthikeyan T, Jacobs CA. Greater prevalence of wound complications requiring reoperation with direct anterior approach total hip arthroplasty. The Journal of arthroplasty 2014. link 35 Unger AS, Stronach BM, Bergin PF, Nogler M. Direct anterior total hip arthroplasty. Instructional course lectures 2014. link 36 De Geest T, Vansintjan P, De Loore G. Direct anterior total hip arthroplasty: complications and early outcome in a series of 300 cases. Acta orthopaedica Belgica 2013. link 37 Martin CT, Pugely AJ, Gao Y, Clark CR. A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. The Journal of arthroplasty 2013. link 38 Mast NH, Laude F. Revision total hip arthroplasty performed through the Hueter interval. The Journal of bone and joint surgery. American volume 2011. link 39 Sugano N, Takao M, Sakai T, Nishii T, Miki H, Nakamura N. Comparison of mini-incision total hip arthroplasty through an anterior approach and a posterior approach using navigation. The Orthopedic clinics of North America 2009. link 40 Echeverri S, Leyvraz PF, Zambelli PY, Jolles BM. Reliable acetabular cup orientation with a new gravity-assisted guidance system. The Journal of arthroplasty 2006. link 41 Pupparo F, Engh CA. Comparison of porous-threaded and smooth-threaded acetabular components of identical design. Two- to four-year results. Clinical orthopaedics and related research 1991. link

    Original source

    1. [1]
      A modified direct anterior approach for primary total hip arthroplasty: surgical technique. — Iorio R, Corsetti F, Fenucci S, Viglietta E, Gugliotta Y, Migliorini F et al. Journal of orthopaedic surgery and research (2025)
    2. [2]
      Indirect comparisons of traction table versus standard table in total hip arthroplasty through direct anterior approach: a systematic review and frequentist network meta-analysis. — Ramadanov N, Voss M, Hable R, Prill R, Hakam HT, Salzmann M et al. Journal of orthopaedic surgery and research (2024)
    3. [3]
      Comparisons between Direct Anterior Approach and Lateral Approach for Primary Total Hip Arthroplasty in Postoperative Orthopaedic Complications: A Systematic Review and Meta-Analysis. — Huang XT, Liu DG, Jia B, Xu YX Orthopaedic surgery (2021)
    4. [4]
      Influence of surgical approach on complication risk in primary total hip arthroplasty. — Miller LE, Gondusky JS, Kamath AF, Boettner F, Wright J, Bhattacharyya S Acta orthopaedica (2018)
    5. [5]
      Prospective comparison of the anterior and lateral approach in hemiarthroplasty for hip fractures: a study protocol. — van der Sijp MPL, Schipper IB, Keizer SB, Krijnen P, Niggebrugge AHP BMC musculoskeletal disorders (2017)
    6. [6]
      Modular acetabular reconstructive cup in acetabular revision total hip arthroplasty at a minimum ten year follow-up. — Sakai T, Ohzono K, Nishii T, Takao M, Miki H, Nakamura N et al. International orthopaedics (2013)
    7. [7]
      Outcomes Following Direct Anterior Approach Total Hip Arthroplasty: A Contemporary Multicenter Study. — Wilson JM, Hadley ML, Larson D, Ledford CK, Bingham JS, Wyles CC et al. The Journal of bone and joint surgery. American volume (2025)
    8. [8]
      Contributions of capsular releases to femoral exposure in total hip arthroplasty via the direct anterior approach. — Han S, Byrd Z, Ismaily SK, Delgadillo LE, Freedhand AM, Rodriguze-Quintana D et al. Clinical biomechanics (Bristol, Avon) (2024)
    9. [9]
      Comparison of Early Postoperative Step and Stair Counts With the Direct Anterior Approach Versus the Posterior Approach for Total Hip Arthroplasty. — Sarhan OA, Imam N, Levine HB, Redfern RE, Seidenstein AD, Klein GR The Journal of arthroplasty (2024)
    10. [10]
      Characteristics and Quality of Online Searches for Direct Anterior Versus Posterior Approach for Total Hip Arthroplasty. — Ren R, Busigó Torres R, Sabo GC, Arroyave JS, Stern BZ, Chen DD et al. The Journal of arthroplasty (2024)
    11. [11]
      Excellent Clinical Outcomes and Return to Dance of 6 Active, Professional Ballet Dancers Aged Younger Than 40 Years at Total Hip Arthroplasty Through Direct Anterior Approach With a Custom Stem: A Case Report. — Nogier A, Tourabaly I, Ramos-Pascual S, Barreau X, Baraduc E, Saffarini M et al. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine (2023)
    12. [12]
      Fluoroscopic Categorization of Cementless Acetabular Component Positioning. — Sadowitz PM, Karlin WM, Lirtzman RA, Kowaleski MP Veterinary and comparative orthopaedics and traumatology : V.C.O.T (2023)
    13. [13]
      A Consistent Anatomic Landmark for Identifying the Lateral Femoral Circumflex Artery in a Direct Anterior Hip Approach. — Harper KD, Nzeogu MI, Vakil JJ, Abdelfadeel WM, Saxena A, Star AM Orthopedics (2022)
    14. [14]
      Acetabular defect management and revision arthroplasty via the direct anterior approach. — Holzapfel BM, Corten K, Goldberg T, Rudert M, Nogler M, Moskal J et al. Operative Orthopadie und Traumatologie (2022)
    15. [15]
      Radiation exposure in fluoroscopy-guided anterior total hip arthroplasty: a systematic review. — Baksh N, Wei L, Ho ES, Zhou JJ, Stekas ND, Eldib AM et al. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie (2022)
    16. [16]
      Postoperative acetabular component position in revision hip arthroplasty: a comparison of the anterior and posterior approaches. — Wilson JM, Schwartz AM, Farley KX, Anastasio AT, Bradbury TL, Guild GN Hip international : the journal of clinical and experimental research on hip pathology and therapy (2022)
    17. [17]
      Real-Time Fluoroscopic Navigation Improves Acetabular Component Positioning During Direct Anterior Approach Total Hip Arthroplasty. — Herrero C, Lavery JA, Anoushiravani AA, Davidovitch RI Bulletin of the Hospital for Joint Disease (2013) (2021)
    18. [18]
      Acetabular Exposure Is Enhanced With Self-Retaining Retractors During Direct Anterior Total Hip Arthroplasty. — Kapilow JM, Gladnick BP, Anderson LA, Peters PC, Masonis JL Orthopedics (2021)
    19. [19]
      Reasons for Failure of Primary Total Hip Arthroplasty Performed Through a Direct Anterior Approach. — Duethman NC, Statz JM, Trousdale RT, Taunton MJ Orthopedics (2020)
    20. [20]
      A retrospective analysis of surgical outcomes following direct anterior hip arthroplasty with or without a surgical extension table. — Knoth C, Zettl R, Markle A, Dullenkopf A, Bruhin V, Hess F International orthopaedics (2020)
    21. [21]
      Are single plane intraoperative and biplanar postoperative radiographic measurements of acetabular cup position the same? — Harold RE, Delagrammaticas D, Keller T, Butler B, Stover MD, Manning DW Hip international : the journal of clinical and experimental research on hip pathology and therapy (2020)
    22. [22]
      Editorial Commentary: What Is an Anatomic Anterior Cruciate Ligament Reconstruction, and Does It Matter? There Are Many Ways to Skin a Cat! — Bedi A Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association (2019)
    23. [23]
      Prospective, Randomized Study of Direct Anterior Approach vs Posterolateral Approach Total Hip Arthroplasty: A Concise 5-Year Follow-Up Evaluation. — Barrett WP, Turner SE, Murphy JA, Flener JL, Alton TB The Journal of arthroplasty (2019)
    24. [24]
      Acetabular revision using a Kerboull-type reinforcement device through direct anterior approach. — Tamaki T, Ninomiya T, Jonishi K, Miura Y, Oinuma K, Shiratsuchi H Journal of orthopaedic surgery (Hong Kong) (2018)
    25. [25]
      Bikini versus traditional incision direct anterior approach: is there any difference in soft tissue damage? — Lanting BA, Hartley KC, Raffoul AJ, Burkhart TA, Sommerville L, Martin GR et al. Hip international : the journal of clinical and experimental research on hip pathology and therapy (2017)
    26. [26]
      Direct anterior approach versus posterolateral approach in total hip arthroplasty : one surgeon, two approaches. — Fransen B, Hoozemans M, Vos S Acta orthopaedica Belgica (2016)
    27. [27]
      Impact of Anterior vs Posterior Approach for Total Hip Arthroplasty on Post-Acute Care Service Utilization. — L'Hommedieu CE, Gera JJ, Rupp G, Salin JW, Cox JS, Duwelius PJ The Journal of arthroplasty (2016)
    28. [28]
      A comparison between the direct anterior and posterior approaches for total hip arthroplasty: the role of an 'Enhanced Recovery' pathway. — Malek IA, Royce G, Bhatti SU, Whittaker JP, Phillips SP, Wilson IR et al. The bone & joint journal (2016)
    29. [29]
      The Anterior Approach for Total Hip Replacement. — Hochfelder JP, Davidovitch RI Bulletin of the Hospital for Joint Disease (2013) (2016)
    30. [30]
      Total hip arthroplasty via the anterior approach: tips and tricks for primary and revision surgery. — York PJ, Smarck CT, Judet T, Mauffrey C International orthopaedics (2016)
    31. [31]
      No differences between direct anterior and lateral approach for primary total hip arthroplasty related to muscle damage or functional outcome. — De Anta-Díaz B, Serralta-Gomis J, Lizaur-Utrilla A, Benavidez E, López-Prats FA International orthopaedics (2016)
    32. [32]
      Intraoperative Fluoroscopy Improves Component Position During Anterior Hip Arthroplasty. — Jennings JD, Iorio J, Kleiner MT, Gaughan JP, Star AM Orthopedics (2015)
    33. [33]
      Comparison of Patient Function during the First Six Weeks after Direct Anterior or Posterior Total Hip Arthroplasty (THA): A Randomized Study. — Christensen CP, Jacobs CA The Journal of arthroplasty (2015)
    34. [34]
      Greater prevalence of wound complications requiring reoperation with direct anterior approach total hip arthroplasty. — Christensen CP, Karthikeyan T, Jacobs CA The Journal of arthroplasty (2014)
    35. [35]
      Direct anterior total hip arthroplasty. — Unger AS, Stronach BM, Bergin PF, Nogler M Instructional course lectures (2014)
    36. [36]
      Direct anterior total hip arthroplasty: complications and early outcome in a series of 300 cases. — De Geest T, Vansintjan P, De Loore G Acta orthopaedica Belgica (2013)
    37. [37]
      A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. — Martin CT, Pugely AJ, Gao Y, Clark CR The Journal of arthroplasty (2013)
    38. [38]
      Revision total hip arthroplasty performed through the Hueter interval. — Mast NH, Laude F The Journal of bone and joint surgery. American volume (2011)
    39. [39]
      Comparison of mini-incision total hip arthroplasty through an anterior approach and a posterior approach using navigation. — Sugano N, Takao M, Sakai T, Nishii T, Miki H, Nakamura N The Orthopedic clinics of North America (2009)
    40. [40]
      Reliable acetabular cup orientation with a new gravity-assisted guidance system. — Echeverri S, Leyvraz PF, Zambelli PY, Jolles BM The Journal of arthroplasty (2006)
    41. [41]
      Comparison of porous-threaded and smooth-threaded acetabular components of identical design. Two- to four-year results. — Pupparo F, Engh CA Clinical orthopaedics and related research (1991)

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