Extensile Femoral Exposure/Femoral Revision Techniques Via the Direct Anterior Approach.

The goal of this chapter is to describe the extensile femoral exposure options and femoral revision techniques using the direct anterior approach (DAA) in total hip arthroplasty. Although DAA is initially described as a muscle-sparing exposure for primary hip arthroplasty, because of its internervous anatomic dissection, the internervous and intermuscular benefits of the DAA are maintained throughout the revision exposure. This distinguishing feature of the DAA must be respected to promote maximal muscle function and stability following revision surgery. Femoral revision exposure can be challenging through any surgical approach. The direct anterior exposure provides a unique access angle to the femur and therefore the incision, releases, osteotomies, and stem insertion techniques differ in many respects from more traditional exposures. The authors hope that this chapter will expose surgeons to the cascade of revision anterior femoral exposure and demonstrate the key elements for successful revision surgery.