Updated: 1/21/2017

THA Approaches

Topic
Review Topic
0
0
Questions
8
0
0
Evidence
5
0
0
Videos
6
Introduction
  • Surgical approach may be dictated by
    • surgeon preference
    • prior incisions
    • obesity
    • risk for dislocation
    • implant selection
    • degree of deformity
  • Standard approaches
    • direct anterior
    • anterolateral
    • direct lateral
    • posterolateral
  • Extensile approaches
    • trochanteric osteotomy
  • "Minimally invasive" approaches    
Direct Anterior Approach
  •  Overview 
    • increasingly popular approach with good long-term results
    • uses interval between tensor fascia lata and sartorious 
  • Advantages
    • decreased dislocation rate when compared to posterior approach in numerous studies
    • abductor mechanism not violated (compared to anterolateral exposure)
    • unsupported advantages include
      • decreased muscle damage
      • decreased pain
      • quicker recovery
  • Disadvantages
    • steep learning curve
      • complication rates decrease after 100+ procedures
    • surgical site infection rates increased in obese patients with large abdominal panni
    • femoral exposure can be challenging
      • may require a special operating room table for increased exposure
    • lateral femoral cutaneous nerve paresthesias
    • intraoperative fracture rate may be higher
Anterolateral Approach
  •  Overview 
    • less commonly used approach for arthroplasty secondary to violation of abductor mechanism and post-operative limp
    • uses interval between tensor fascia lata and gluteus medius
  • Advantages
    • lower dislocation rate than posterior approach
  • Disadvantages
    • violates abductor mechanism
      • may lead to postoperative limp
Direct Lateral Approach
  •  Overview 
    • less commonly used approach for arthroplasty secondary to violation of abductor mechanism and post-operative limp
    • no true interval
      • splits gluteus medius and vastus lateralis
  • Advantages
    • lower dislocation rate than posterior approach
    • allows access to both anterior and posterior hip joint without osteotomy
  • Disadvantages
    • violates abductor mechanism
      • may lead to postoperative limp
    • heterotopic ossification is common
Posterolateral Approach
  •  Overview 
    • most common approach for primary and revision arthroplasty
    • no true interval
  • Advantages
    • abductor mechanism not violated
    • excellent exposure of both femur and acetabulum
    • easily converted to more extensile exposures both proximally and distally
  • Disadvantages
    • dislocation rates may be higher than anterior exposures
Extensile Approaches
  •  Trochanteric osteotomy 
    • overview
      • 3 types
        • standard trochanteric osteotomy
        • trochanteric slide
        • extended trochanteric osteotomy  
      • useful for difficult primary and revision hip arthroplasty
    • advantages
      • excellent acetabular exposure
      • useful for component removal
    • disadvantages
      • complications include
        • non-union
        • heterotopic ossification
        • trochanteric bursitis
        • abductor weakness
      • extended trochanteric osteotomy requires diaphyseal engaging stem
 

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Questions (8)

(OBQ06.89) A minimal-incision technique with an incision no more than 10 centimeters has which of the following advantages compared to a standard incision for a total hip replacement? Review Topic

QID: 200
1

lower post-operative visual analogue pain score

5%

(121/2503)

2

less transfusion requirement

3%

(67/2503)

3

shorter length of stay

3%

(85/2503)

4

better cosmetic result

88%

(2192/2503)

5

less pain medication requirement

1%

(33/2503)

ML 1

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PREFERRED RESPONSE 4
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(OBQ06.232) During a minimally invasive approach to total hip arthroplasty a femoral periprosthetic fracture occurs. Which of the following steps is crucial to properly treat this complication? Review Topic

QID: 243
1

Transitioning to an extensile approach to adequately visualize and reduce the fracture

93%

(2111/2275)

2

Limiting post-operative weight bearing

4%

(99/2275)

3

Switching to a cemented femoral stem to avoid the stresses created during press-fit fixation

2%

(49/2275)

4

Delaying the arthroplasty until the fracture has healed

0%

(1/2275)

5

Supplementing the fracture with autograft

0%

(6/2275)

ML 1

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PREFERRED RESPONSE 1
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ARTICLES (6)
VIDEOS (6)
Topic COMMENTS (4)
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