The use of an Antiprotrusio Cage in Acetabular Reconstruction for Periprosthetic Transverse Fracture through a Direct Anterior Approach - Case Report

Sep 29, 2026

Periprosthetic acetabular fractures after total hip arthroplasty (THA) present a rare but difficult problem, especially in patients previously operated on via the direct anterior approach (DAA). This case report describes a 64-year-old woman with a transverse acetabular fracture and medial cup migration with a VancouverAG fracture following a fall. An extensile DAA with an anterior-implant antiprotrusio (Burch–Schneider) cage minimized instability while enabling exposure and preserved the femoral component. Early mobilization restored pre-injury function within 6 months.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Abstract

Introduction

Case Report

Conclusion

Keywords

Case Report Journal of Orthopaedic Case Reports 2025 December:15( 12) :Page 40-45 The use of an Antiprotrusio Cage in Acetabular Reconstruction for Periprosthetic Transverse Fracture through a Direct Anterior Approach: ACase Report Andrea Giani1, Giacomo Moraca1, Marco Cuzzolin1, Gherardo Pagliazzi1 Learning Point of the Article: The extensile direct anterior approach is a viable and effective option for complex acetabular revisions using an anti-protrusion cage, allowing for adequate exposure, component stability, and early mobilization. Abstract Introduction: Periprosthetic acetabular fractures following total hip arthroplasty (THA) represent a rare but challenging condition, particularly in patients with previous surgeries through the direct anterior approach (DAA). The case described is, to our knowledge, the first report of a central dislocation of the acetabular component treated using a Burch–Schneider anti-protrusion cage through an extensile DAA. This surgical choice was aimed at minimizing instability and optimizing exposure in a complex revision setting, thus offering an innovative contribution to the orthopedic literature. Case Report: A 64-year-old Caucasian female affected by ischemic vascular transverse myelopathy leading to asymmetric paraparesis, with greater involvement of the right lower limb, presented after a fall on her previously operated left hip. She underwent THA 2 years earlier. Radiological evaluation revealed a transverse acetabular fracture with medial cup migration and an associated VancouverAG fracture. Given the patient’s reliance on the left limb for mobility and the risks of instability from multiple surgical approaches, therevision was performed through an extensile DAA. An antiprotrusio cage specifically designed for anterior implantation was used, and the femoral component was preserved. Early mobilizationwas initiated postoperatively, with the patient regaining pre-injury mobilitywithin 6 months. Conclusion: This case demonstrates the feasibility and benefits of using the extensile DAA in managing complex acetabular defects with a Burch–Schneider antiprotrusio cage. It highlights a surgical strategy that may reduce the risk of instability and improve functional outcomes in selected patients. The originality of this case lies in the use of an anterior approach to address a complication with a reconstruction technique typically reserved for posterior approaches. This report contributes to expanding the surgical options in revision hip arthroplasty and provides new insights into optimizing careinpatients with complex anatomical and functional constraints. Keywords: Hip, prosthesis, acetabular fracture, revision, extensile direct anterior approach, antiprotrusiocage. Introduction The incidence of primary total hip arthroplasty (THA) has been rising significantly, leading to a dramatic increase in THA revisions, atrend expected to continue indirect proportion to the exponential growth of primary THA in the upcoming decades [ 1, 2, 3] . Despite advancements in surgical technique and technology, revision THA for large acetabular defects remains challenging, even for the most experienced arthroplasty surgeons. In many cases, limited host bone stock hinders the conventional implantation ofstable prosthetic components [4]. |
Access this article online

Website: [www.jocr.co.in](www.jocr.co.in)

DOI:
[https://doi.org/10.13107/jocr.2025.v15.i12.6448](https://doi.org/10.13107/jocr.2025.v15.i12.6448) | Author’s Photo Gallery | | | | | --- | --- | --- | --- | --- | | | | | | | | |
1Department of Orthopaedics and Traumatology, Lugano Regional Hospital, Lugano, Switzerland.
Address of Correspondence:
Dr. Giacomo Moraca,
Department of Orthopaedics and Traumatology, Lugano Regional Hospital, Via Tesserete 46, 6900 Lugano, Switzerland.
E-mail: moraca.giacomo@gmail.com | | | | | Submitted: 30/09/2025; Review: 27/10/2025; Accepted: Novem

FAQs

What surgical approach and implant were used to treat the acetabular fracture in this case report?

The fracture was managed using an extensile direct anterior approach (DAA) with a Burch–Schneider antiprotrusion cage placed via an anterior implantation. The femoral component was preserved.

What did the preoperative imaging show before the revision surgery?

Radiology revealed a transverse acetabular fracture with medial cup migration and an associated VancouverAG fracture.

What outcomes were reported after the revision, including mobilization and functional recovery?

Early postoperative mobilization was initiated, and the patient regained pre-injury mobility within 6 months. The authors emphasize feasibility and potential benefits for complex acetabular defects using this strategy.

Sep 29, 2026

Uploaded by LangkahRina