Pneumatic femoral broaching in direct anterior approach hip arthroplasty

Aim The aim of this study is to report the safety and efficacy of the Woodpecker pneumatic broaching system in direct anterior hip arthroplasty. Methods 649 primary elective anterior bikini total hip arthroplasties (THA) using Woodpecker broaching over a 5-year period were included. Patients undergoing a THA through a different surgical approach, revision THA or arthroplasties for hip fractures were excluded (n=219). Preoperative and postoperative Harris Hip Scores (HHS) and postoperative radiographs were analysed to identify femoral fractures and femoral component positioning. Complications and component survivorship until most recent follow-up were analysed. Results The average time taken for femoral preparation using Woodpecker broaching system was 2.8 min (1.4-7.5 min) in both cemented and uncemented THAs. Radiographic analysis revealed 67.3% of the stems were placed in 0 degrees-1.82 degrees of varus and 32.7% placed in 0 degrees-1.4 degrees of valgus. Average HHS were 24.4 preoperatively, with significant improvements at 6 weeks (80.95), 6 months (91.91) and 12 months (94.18) of follow--up. Complications not directly attributed to Woodpecker broaching included three intraoperative femoral fractures (0.4%), three periprosthetic postoperative fractures (0.3%), two cases of stem subsidence (0.3%) and two wound infections (0.3%). At the most recent follow--up, the survivorship of the acetabular component was 99.7% and the femoral component was 99.1%, with mean follow-up of 2.9 years (0.5-5 years). Conclusion The pneumatic Woodpecker device is a safe and effective alternative tool in minimally invasive direct anterior hip replacement surgery for femoral broaching performed on a standard table.