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Combined posterolateral and direct anterior approaches improve outcomes in complex hip arthroplasty for osteonecrosisNew surgical approach helps man with severe hip bone damage

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Key Takeaway
Note that dual-incision techniques may improve outcomes in complex osteonecrosis cases but evidence is limited by sample size.

This case report describes a surgical intervention for a 51-year-old male with bilateral osteonecrosis of the femoral head and a 10-cm massive heterotopic osteophyte of the right hip. The patient underwent total hip arthroplasty using a combined posterolateral approach (PLA) and direct anterior approach (DAA). This dual-incision strategy was employed to provide 360-degree visualization and reduce neurovascular injury risk in the presence of severe anatomical distortion.

At a 3-month follow-up, the patient showed significant clinical improvement. Pain resolved completely, and the Harris hip score increased from 50 to 98. Functional mobility improved as evidenced by the Timed Up and Go (TUG) test, which decreased from 18 s to 8.5 s. No adverse events were reported during the procedure.

The authors suggest that the dual-incision strategy is an effective salvage technique for complex cases involving significant anatomical distortion. However, because this is a single case report, the findings cannot be generalized to the broader population of patients with osteonecrosis of the femoral head. The certainty of these results is low due to the limited sample size.

How this fits prior evidence

This case report addresses a surgical management gap for complex hip arthroplasty in cases of osteonecrosis of the femoral head. While prior coverage noted that high-dose stem cell therapy with core decompression may reduce hip failure risk, this report focuses on a surgical salvage technique using combined PLA and DAA approaches to manage severe anatomical distortion.

Imagine living with severe hip joint damage that makes every step painful. For one 51-year-old man, this meant dealing with both bone death in both hips and a massive growth of extra bone tissue. This combination made standard surgery difficult because the anatomy was so distorted.

Doctors used a combined surgical technique involving two different approaches to replace his hip joint. By using these dual incisions, they were able to see the area clearly while protecting important nerves. Three months after the operation, the man saw significant improvements. His pain disappeared completely, and his mobility scores improved significantly.

While this specific case showed great success, it is important to remember that this was a single patient study. Because it only involved one person, we cannot know if this method works for everyone with similar conditions. It serves as a promising example of how surgeons can tackle complex anatomical problems.

What this means for you:
A dual-incision surgical technique successfully treated a man with severe hip bone damage and pain.

Common questions

What did the patient experience after the surgery?

Three months after the procedure, the patient's pain resolved completely. His ability to move improved significantly, with his Timed Up and Go test score improving from 18 seconds down to 8.5 seconds. His overall hip health score also jumped from 50 to 98.

How did the surgeons manage the complex bone growth?

The doctors used a combined approach involving two different surgical paths. This dual-incision strategy allowed them to see all sides of the joint clearly while reducing the risk of damaging important nerves like the femoral or sciatic nerves.

Is this surgery safe for everyone with hip issues?

In this specific case, the procedure was completed without any reported complications. However, because this report only followed one patient, it is not possible to say if this method works for every person with similar conditions.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
BackgroundThis 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.Case presentationWe 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, in situ femoral neck osteotomy, and precise prosthetic implantation.OutcomeThe 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.ConclusionFor complex total hip arthroplasty (THA) involving severe anatomical distortion, a dual-incision strategy combining PLA and DAA enables safe surgery under 360°direct visualization. This approach serves as an effective salvage technique that reduces the risk of neurovascular injury.
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