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 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 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 11 1 2 3 4 5 6 7 8 9 10 11 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 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? Tested Concept QID: 200 Type & Select Correct Answer 1 lower post-operative visual analogue pain score 5% (175/3739) 2 less transfusion requirement 3% (100/3739) 3 shorter length of stay 4% (132/3739) 4 better cosmetic result 88% (3272/3739) 5 less pain medication requirement 1% (50/3739) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept (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? Tested Concept QID: 243 Type & Select Correct Answer 1 Transitioning to an extensile approach to adequately visualize and reduce the fracture 92% (3108/3360) 2 Limiting post-operative weight bearing 4% (144/3360) 3 Switching to a cemented femoral stem to avoid the stresses created during press-fit fixation 2% (84/3360) 4 Delaying the arthroplasty until the fracture has healed 0% (3/3360) 5 Supplementing the fracture with autograft 0% (9/3360) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept
All Videos (9) Podcasts (1) Login to View Community Videos Login to View Community Videos 2019 Orthopaedic Summit Evolving Techniques Evolving Technique: My Extended Trochanteric Osteotomy (ETO) To Revise A Cemented Femoral Component With A Vancouver B1, B2 Or B3 Fracture - Simon Mears, MD Simon Mears Recon - THA Approaches 12/2/2020 56 views 0.0 (0) 2019 Orthopaedic Summit Evolving Techniques Set Up On The Table- Fewer Releases, Fewer Assistants, Better Results - Don't Worry! - Debate: 69-Year-Old Former Professional Tango Dancer Requesting Anterior Total Hip Replacement - Stefan W. Kreuzer, MD Recon - THA Approaches 11/2/2020 346 views 4.3 (3) Login to View Community Videos Login to View Community Videos Anterior THA Exposure and Capsule Management - Dr. J. Bohannon Mason Bo Mason Recon - THA Approaches B 8/19/2019 781 views 5.0 (5) ReconâȘTHA Approaches Orthobullets Team Recon - THA Approaches Listen Now 14:4 min 5/12/2020 164 plays 5.0 (2) See More See Less