The Hip: Preservation, Replacement and Revision

Initial Exposure for THR:


    - positioning and prepping   
    - posterolateral skin incision 
    - incise thru iliotibial band 
    - split gluteus maximus 

    - peel back the trochanteric bursa:
          - divide trochanteric bursa and sweep it posteriorly to expose vastus lateralis, short external rotators and posterior border of gluteus medius;
          - this step should be performed carefully so that the surgeon can cleanly dissect the external rotators off their insertion on the greater trochanter;
          - once the bursa has been swept posteriorly, the surgeon will have the proper plane to identify the sciatic nerve, and also the interval between the piriformis and medius;
    - identify the sciatic nerve
    - charnley retractors:
          - insert Charnely retractor at the superior border of the greater trochanter;
          - retract maximus posteriorly & tensor fascia anteriorly;
          - ensure that the Charnely retractor has not been placed directly over the sciatic nerve;
    - elevate minimus off the superior acetabular roof;
          - this is facilitated by inserting a homan retractor underneath the medius and then retracting it anteriorly;
          - subsequently a periosteal elevator is used to elevate the minimus;
    - measure leg lengths:
    - dissect the external rotators and the posterior capsule off proximal femur:
    - hip dislocation: technique


- references:

          - Comparison of Primary Total Hip Arthroplasties Performed with a Minimally Invasive Technique or a Standard Technique. A Prospective and Randomized Study.
          - Surgical approaches for primary total hip arthroplsty. A prospective comparison of the Marcy modification of the Gibson and Watson-Jones approaches.
          - The trochanteric approach to the hip for prosthetic replacement.
          - The direct lateral approach to the hip for arthroplasty. Advantages and complications.
          - Comparison of heterotopic bone after anterolateral, transtrochanteric, and posterior approaches for total hip arthroplasty.
          - The transgluteal approach to the hip joint.  
          - Comparison of the transtrochanteric and posterior approaches for total hop replacement
          - Comparison of complications after transtrochanteric and posterolateral approaches for primary total hip arthroplasty
          - Comparison of Primary Total Hip Replacements Performed with a Standard Incision or a Mini-Incision. 



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, January 7, 2013 3:40 pm