Introduction Provides exposure to acetabulum proximal femur Indications include THR minimally invasive approach does not improve post-op gait kinematics when compared to traditional trans-gluteal approach patient at high risk for dislocation may benefit from antero-lateral approach since no posterior soft tissue disruption some concern that this approach can weaken the abductor and cause limping hemiarthroplasty ORIF of femoral neck fracture synovial biopsy of hip biopsy of femoral neck Intermuscular plane Between tensor fasciae latae (superior gluteal nerve) gluteus medius (superior gluteal nerve) Preparation Anesthesia general or spinal/epidural is appropriate Position generally performed in the lateral decubitus position patient's buttock close to the edge of the table to let fat fall away from incision Landmarks ASIS greater trochanter shaft of the femur Approach Incision make incision starting 2.5 cm posterior and distal to ASIS as it runs distal, it becomes centered over the tip of the greater trochanter crosses posterior 1/3 of trochanter before running down the shaft of the femur Superficial dissection incise fat in line with incision and clear fascia lata incise fascia incise in direction of fibers, this will be more anterior as your dissect proximal incise at the posterior border of the greater trochanter develop interval between tensor fasciae latae and gluteus medius there will be a small series of vessels in this interval externally rotate the hip to put the capsule on stretch identify origin of vastus lateralis Deep dissection detach abductor mechanism by one of two mechanisms trochanteric osteotomy (shown in this illustration) distal osteotomy site is just proximal to vastus lateralis ridge partial detachment of abductor mechanism place stay suture to prevent muscle split and damage to superior gluteal nerve nerve is 5cm proximal to the acetabular rim expose anterior joint capsule detach reflected head of rectus femoris from the joint capsule to expose the anterior rim of the acetabulum easier with leg flexed slightly elevate part of the psoas tendon from the capsule perform anterior capsulotomy dislocate hip with external rotation Extension proximal incise more fasciae latae proximally to allow increased adduction and external rotation of the leg distal incise down the deep fascia of the leg allows access to the vastus lateralis which can be elevated to allow direct access to the entire femur Dangers Femoral nerve most common problem is compression neuropraxia caused by medial retraction direct injury can occur from placing retractor into the psoas muscle Femoral artery and vein can be damaged by retractors that penetrate the psoas confirm that anterior retractor is directly on bone Abductor limp caused by trochanteric osteotomy and/or disruption of abductor mechanism caused by denervation of the tensor fasciae by aggressive muscle split Femoral shaft fractures usually occurs during dislocation (be sure to perform and adequate capsulotomy)
QUESTIONS 1 of 3 1 2 3 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ11.186) A 67-year-old male with severe hip arthritis presents for evaluation of a total hip arthroplasty. The patient is requesting a minimally invasive Watson-Jones approach, as he has heard post-operative mobility is significantly improved compared with a traditional transgluteal technique. What should the patient be told to expect regarding early post-operative gait kinematics when comparing these surgical approaches? QID: 3609 Type & Select Correct Answer 1 The minimally invasive Watson-Jones approach results in improved gait velocity, cadence, and step length 12% (429/3708) 2 There is no difference in early gait kinematics between the two approaches 68% (2538/3708) 3 The minimally invasive Watson-Jones approach results decreased gait velocity and stride length 7% (277/3708) 4 The traditional transgluteal approach results in worse early gait kinematics 11% (391/3708) 5 Early gait kinematics is dependent only on the type of prosthesis used, not surgical approach 2% (56/3708) L 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
All Videos (1) Podcasts (1) Login to View Community Videos Login to View Community Videos Minimally Invasive Total Hip Replacement via Anterolateral Approach - Dr. M Krieger Anay Patel Approaches - Hip Anterolateral Approach (Watson-Jones) B 3/24/2013 4243 views 4.7 (15) Approaches | Hip Anterolateral Approach (Watson-Jones) Approaches - Hip Anterolateral Approach (Watson-Jones) Listen Now 12:16 min 5/1/2021 452 plays 0.0 (0)