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) No difference in gait biomechanics at 3 months compared to other approaches 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 thought to 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 postsa-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 risk reduced with repair of capsule and short external rotators 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
QUESTIONS 1 of 13 1 2 3 4 5 6 7 8 9 10 11 12 13 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ18.83) A 61-year-old man with left hip OA presents to clinic for persistent left hip pain despite a trial of conservative therapy. The decision is made to proceed with total hip arthroplasty via a direct anterior approach. Which of the following correctly describes the superficial internervous plane of this approach? QID: 212979 Type & Select Correct Answer 1 Rectus femoris (femoral n.) & tensor fascia lata (superior gluteal n.) 6% (156/2427) 2 Tensor fascia lata (femoral n.) & sartorius (superior gluteal n.) 10% (231/2427) 3 Rectus femoris (femoral n.) & gluteus medius (superior gluteal n.) 1% (22/2427) 4 Sartorius (femoral n.) & gluteus medius (superior gluteal n.) 1% (23/2427) 5 Sartorius (femoral n.) & tensor fascia lata (superior gluteal n.) 82% (1980/2427) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ15.206) A 70-year-old male returns to your clinic having decided to pursue hip replacement for his intractable pain. Which of the following scenarios is associated with the greatest risk of dislocation following primary total hip arthroplasty? QID: 5891 Type & Select Correct Answer 1 Smith-Peterson approach with failed capsular repair 13% (310/2478) 2 Watson-Jones approach with direct penetration of iliospoas with retractors 3% (76/2478) 3 Hardinge approach with acetabular cup placement in 40 degrees of abduction 4% (104/2478) 4 Direct anterior approach with 15 degrees of anteversion 3% (82/2478) 5 Moore approach to the hip with capsulectomy 76% (1885/2478) L 4 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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? QID: 200 Type & Select Correct Answer 1 lower post-operative visual analogue pain score 5% (208/4200) 2 less transfusion requirement 3% (112/4200) 3 shorter length of stay 4% (151/4200) 4 better cosmetic result 87% (3660/4200) 5 less pain medication requirement 1% (58/4200) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (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? QID: 243 Type & Select Correct Answer 1 Transitioning to an extensile approach to adequately visualize and reduce the fracture 92% (3632/3948) 2 Limiting post-operative weight bearing 4% (170/3948) 3 Switching to a cemented femoral stem to avoid the stresses created during press-fit fixation 3% (113/3948) 4 Delaying the arthroplasty until the fracture has healed 0% (5/3948) 5 Supplementing the fracture with autograft 0% (12/3948) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic
All Videos (48) Podcasts (1) Login to View Community Videos Login to View Community Videos Orthopaedic Summit Evolving Techniques 2021 Pro - This Athlete Needs a Perfectly Done Primary THA He Will be Skiing in No Time - Jeffrey B. Stambough, MD Jeff Stambough Recon - THA Approaches 1/24/2023 27 views 0.0 (0) Login to View Community Videos Login to View Community Videos Anterior Hip Foundation 2023 Innovation Symposium Efficient Direct Anterior (EDA) Hip - Kristoff Corten, MD Kristoff Corten Recon - THA Approaches 1/23/2023 41 views 0.0 (0) Login to View Community Videos Login to View Community Videos Anterior Hip Foundation 2023 Innovation Symposium Debate: What is the Best Technology from the Front? David Crawford Cory Calendine Brian Perkinson Recon - THA Approaches 1/23/2023 17 views 0.0 (0) ReconâȘTHA Approaches Recon - THA Approaches Listen Now 14:29 min 5/12/2020 610 plays 5.0 (2) See More See Less