hardinge approach hip precautions hardinge approach hip precautions

The approaches are posterior (Moore or southern), lateral (Hardinge or Liverpool), antero-lateral (Watson-Jones), anterior (Smith-Petersen) and greater trochanter osteotomy. The vastus lateralis and the gluteus medius are now exposed. Each hip replacement approach has its own specific restrictions. Modified Hardinge Approach for Total Hip Arthroplasty. This depends on what approach was utilized to do the hip replacement . - alcoholism: Damage to the superior gluteal nerve after the Hardinge approach to the hip. - ensure that the sterile drapes are tied together underneath the operating room table (by the unscrubbed assistant) so that the drapes do not slide off the table as the leg is placed in the saddle bag; - Final Trial: . . Use retractors as necessary to expose the femoral head and neck. A surgical incision, approximately 6 cm in size, is made to the anterolateral side of the thigh to gain access to the hip joint. The direct lateral approach to the hip for arthroplasty. Dr. Robert Donaldson, DC, PT. Age In Place School is a participant in affiliate advertising programs designed to provide fees by advertising and linking to their products. #reeltruthscience,#hipapproach,#hipfractures,#surgicalapproach,#hardingeapproach,#hardinge,#anterolateralapproachtothehip, #hiparthrotomy,#hipcapsule,#hipfra. Traditionally, protocols describing these restrictions and precautions require patients to sleep supine (usually with an abduction pillow in place), to use walking aids for several weeks, only to sit on high chairs and not to sit cross-legged, not to bend forward or to flex their hip joint beyond 90. Start the slightly anteriorly curved skin incision about 7-10 cm proximal of the lateral part of the greater trochanter (directed towards the tubercle of the iliac crest the posterior landmark of tensor fasciae latae origin). Because of this, I recommend my posterior approach hip replacements follow the three restrictions for the rest of their lives. See Also: Hip Joint Anatomy Hardinge Approach to Hip Joint indications. in 1954, and was modified by Hardinge in 1982. The proximal part of the incision is limited by the superior gluteal nerve and vessels, crossing 3-5 cm proximal to the tip of the greater . But there is also more than one way to go about performing a hip replacement surgery - known as different "approaches.". - if the surgeon attempts to correct the contracture by performing an aggressive anterior capsulotomy, then there is an increased risk of dislocating out the front; - PreOp: The vastus lateralis muscle is also split in its own line lateral to the point where it is supplied by the femoral nerve. Filed Under: https://www.tandfonline.com/doi/abs/10.1080/09638288.2020.1722262, http://www.sunnybrook.ca/content/?page=musckuloskeletal-hip-replacement-walking, https://www.youtube.com/watch?v=VfADxKAGdYM, https://www.youtube.com/watch?v=8OsN2J8HR6Q, https://www.youtube.com/watch?v=CUSSqFtolTU&app=desktop, https://www.physio-pedia.com/index.php?title=Hip_Precautions&oldid=324619. The approach does not give as wide an exposure as the anterolateral approach to hip joint with trochanteric osteotomy. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. Lateral traction and repositioning of the leg can improve visualization. Hamstring Curl Machine (hip precautions) 9. You are in: Home Approach Hip Approaches Hardinge Approach. After dissecting the fat,look for the thick white layer which is the fascia. Hardinge K. The direct lateral approach to the hip. How To Choose A Surgeon For Hip Replacement, Speed Up Recovery After Total Hip Replacement, Can I Sit In A Recliner After Hip Replacement, Crossing Legs After Total Hip Surgery: (A PTs Complete Guide), Stairs After Total Hip Replacement: A Physical Therapy Guide, Ice After Total Knee Replacement: A PTs Complete Guide. The layers being encountered are: The anterior (Smith-Peterson) approach accesses the joint from the front. if(typeof(jQuery)=="function"){(function($){$.fn.fitVids=function(){}})(jQuery)}; Orthopaedic Specialists of North Carolina. He owns and operates an orthopedic physical therapy practice. No hip extension. Direct Anterior Approach Total Hip Arthroplasty 10:21. When sitting or standing from a chair, bed or toilet you must extend your operated leg in front of you. This technique is a unique and innovative method of performing a hip replacement. Expose the fascia lata sharply. The thoroughly updated Fifth Edition is completely reorganized and has new, expanded treatment and exercise sections in each chapter. Additionally, there are many variations of the Anterior, Posterior, and Lateral surgical approaches and each surgeon has their own range-of-motion restrictions.Always follow the surgeons specific range-of-motion restrictions, the surgeon is the only one that knows exactly what was done during the surgery. This . By reducing the size of their incisions to as small as 2.5 inches, they hope to reduce soft tissue damage and speed healing. Neither the anterior nor the posterior capsule is cut in this approach. Do not go more proximal than 5 cms because the superior gluteal artery and nerve which supplies the abductor muscles, runs across the incision here and can get damaged on deeper dissection. stream Our mission is to share information and our experience, both as senior citizens and physical therapists, to help people age in place independently. - Positioning: Telephone: 410.494.4994, Modified Hardinge Anterolateral Approach to the Hip, Partial anterior trochanteric osteotomy in total hip arthroplasty: Surgical technique and preliminary results of 127 cases, Acetabular Exposure and Preparation for Reaming. See "About Me" page. Hardinge Approach to Hip Joint (or Direct Lateral Approach)allows excellent exposure to the hip joint for joint replacement. ^!#*\E'l[l`}c5f ;mr$"d^M5!%T/FSQK]0V9]VCfId ykOP]hHE{0aSI4Zv/ZIyO{ j2xm;nS6wR71]48"NYMa&!MrvN1kwOQJsdB+PO ~SD8LyX^0n;qGNqeB{.-I&n(TFKgF>!8 A%6M?K]uj)F$~/hrrO2_TB uPa&))xB4%n TA !RRrj;5I.rn8CM},jvJm,[jbF$OT>]/{GVxTq2NcEt|EJ'ki Q{6s8*%EM8QL'gbsG-[a*"$lA[H[F4rW* a M1|mA}y$1u5wa Towson, MD 21204 - consider removal of anterior portion of abductors w/ attached thin wafer of bone from anterior edge of greater trochanter to facilitate later repair; Dislocation Precautions: Dislocation precautions are based on surgical approach and the direction in which the hip is dislocated intra-operatively (if at all) to gain exposure to the joint. Organize in-house training events for your surgical staff, Hand Distal phalanges revision published. You will need to detach the muscles from the greater trochanter either by sharp dissection or by lifting off a small flake of bone. Total hip arthroplasty (THA) is generally considered to be one of the most successful orthopedic surgical procedures. Release the capsule sufficiently anteroinferiorly and anterosuperiorly to expose the femoral head and neck and permit free external rotation of the femur. An EMG and clinical review. Next, develop an anterior flap that consists of the anterior part of the gluteus medius muscle with its underlying gluteus minimus and the anterior part of the vastus lateralis muscle. Approach. A modified anterolateral approach. The surgeon uses a special surgical table specifically designed to position the patient so that the hip joint may be easily accessed from the front as opposed to the side or back. Risk of dislocation & hip precautions: Risk is incredibly low (<1%). Hardinge Approach to Hip Joint (Direct Lateral Approach) is used for: There is no true internervous plane for Hardinge approach to hip joint (direct lateral approach). It provides information to make you a better-informed consumer. nZ!g Close also the gluteus medius tendon and fascia proximally, and the vastus lateralis fascia distally. I dont expect my patients to be as strict with the restrictions after 12 weeks but I do expect them to be aware of the restrictions and follow them as best they can after the 12-week mark. In: Frontera WR, Silver JK, Rizzo TD, eds. The Micro-Posterior Tissue Sparing approach aims to get patients back on their feet within days (possibly hours) instead of weeks. The capsule is one of the primary dislocation prevention structures, so care is taken by restricting range-of-motion until the capsule is well healed and capable of resisting dislocation. Damage to the superior gluteal nerve after the Hardinge approach to the hip. Do not go more than 3 cm above the upper border of the trochanter because more proximal dissection may damage branches of the superior gluteal nerve. The approach does not give as wide an exposure as theanterolateral approach to hip jointwith trochanteric osteotomy. Courtesy: Malek Racey, UK It can be protected by limiting proximal incision of gluteus medius muscle and putting a stay suture at the apex of gluteal split. Sterile dressing should be applied, and negative pressure incisional wound care can be considered. This site does not constitute medical advice. UCLA health. There is a layer between the fascia and muscle which is the trochanteric bursa. Derek Donegan, Michael Huo, Michael Leslie. See My Other Total Hip Replacement Articles: How To Choose A Surgeon For Hip ReplacementSpeed Up Recovery After Total Hip ReplacementCan I Sit In A Recliner After Hip ReplacementCrossing Legs After Total Hip Surgery: (A PTs Complete Guide)Stairs After Total Hip Replacement: A Physical Therapy GuideIce After Total Knee Replacement: A PTs Complete Guide. More about minimally invasive hip approaches >>, More about the Micro-Posterior tissue sparing approach >>. Hardinge Approach to Hip Joint (Direct Lateral Approach) cannot be extended proximally. The mean hip score was 80. Draw a line between the anterior one third and posterior two thirds of the muscle and that line would be the line in which we split the muscle fibres. Exposure of the hip using a modified anterolateral approach. I'm leaning towards not having this operation. Total hip replacement. Do not roll or lie on the unoperated side for the first 6 weeks, Do not twist the upper body when standing, The patient may benefit from a shower chair or elevated seat for home use, Avoid bathing for 8 to 12 weeks (flexed and bent down in the tub). This capsulotomy shows the prosthesis. Direct lateral approach also called as the trans-gluteal approach initially described by Kocher in 1903 popularised by Hardinge in the modern age gives good exposure to the hip joint preserving most of gluteus medius minimus and vastus lateralis, and the vascularity. endobj Fascia, PRECAUTIONS X 6 WEEKS Wear TED Hose Sleep on back Pillow under ankle, NOT under knee - keep foot of bed flat Pillow between legs while sleeping No active Abduction exercises No straight leg raise (SLR) No Flexion > 90 degrees No ER > 30 degrees No Extension > 30 degrees No Adduction past midline POST-OP WEEKS 1 - 6 Data Trace is the publisher of Close the fascia lata incision with interrupted sutures. jwplayer('jwplayer_IwFksVzC_vRGjQ34u_div').setup( Make a T-shaped incision in the capsule, if necessary, for exposure. Data Trace Publishing Company There are two small incisions made in this approach, one being the main access to the joint and through which nearly all the work is performed. A common way the No Crossing Mid-line rule is broken is by sleeping on the unoperated side and allowing the operated leg to drop down to the bed crossing the mid-line. mini-incision approach shows no longterm benefits to hip function extend to 10 cm below tip of greater trochanter Superficial dissection through subcutaneous fat incise fascia lata in lower half of incision extend proximally along anterior border of gluteus maximus split gluteus maximus muscle along avascular plane This mistake can be avoided by placing a body pillow between the legs when lying on the unoperated side, but the operated leg MUST be supported from the groin to past the ankle. They require ligation or cautery. They understand the concept of not crossing their legs at the ankles but most of my patients do not know what dont cross your legs at the knee instructions mean. Replacement is designed to precisely reconstruct the hip without stretching or traumatizing muscles that are important to hip function. in forum only (options) J')(o@ct9\ The anterolateral approach (Watson-Jones) to the proximal femur, through the interval between glutei and tensor fasciae latae provides somewhat limited access to the hip joint along with the lateral proximal femur. 8. The motion that would put the new hip in this extreme extension with external rotation would be something like kneeling on the operated leg with the foot turned out, then moving body weight forward onto the opposite foot. The standard approach used in our hospital for THR in NOF fractures is the modified Hardinge approach to the hip. The posterior capsule and muscles are not cut. The GJNH recommends patients follow hip precautions for 12 week post THA using both posterior and modified Hardinge anterolateral approach and irrespective of type of prosthesis. Being compliant with range-of-motion restrictions for 12 weeks after Anterior, Posterior or Lateral hip replacement approach allows the joint capsule to heal and shrink enough to resist dislocation.Posterior and Lateral surgical approach restrictions are completely different than for an Anterior surgical approach. Because of the impaired accuracy which can occur because of lack of visualization of the joint, surgeons performing MIS generally use computer-assisted guidance systems. 1 0 obj Hip dysplasia can present unique challenges in achieving stability with THA and, as such, there is a higher incidence of instability . Does anyone know someone who didn't get it when they needed it? Many surgeons will prescribe a hip abduction brace to remind the patient they are not allowed to actively abduct the leg. Exposure of the proximal femur is gained by gentle external rotation of the leg. Adjust the retractors as necessary and debride periarticular fat to expose the hip capsule. Getting up from sitting, the patient must consciously remember to scoot to the front of the chair, extend the operated legs knee, and push themselves up with their arms and unoperated leg while keeping their trunk erect. Recent studies have found that hip precautions impact patients recovery both physically and psychologically. This information is provided as an educational service and is not intended to serve as medical advice. How To Generate Retirement Income: Cash In On Your Knowledge. The trochanteric approach to the hip for prosthetic replacement. For hip arthroplasty, retraction of the proximal femur distally will allow removing the femoral head fragment from the acetabulum. The joint capsule seals the hip joint, much like a zip-lock baggie, to keep the lubricating fluids inside the capsule and bathing the hip joint in this fluid. 4, 5 The . Advance to treadmill D. Recommended long-term activities after Total Hip Replacement (DeAndrade, KJ - Activities after replacement of the hip or knee, Orthopedic Special Edition 2(6):8, 1993) <> Hip Precautions - Anterior Approach Available from: Harkess JW, Crockarell JR. Arthroplasty of the hip. Hardinge Approach to Hip Joint indications. endobj <>>> Muscle, Precautions include: This 2 minute video reviews the three main hip precautions used for several weeks after posterior THR to prevent complications such as dislocation. This often requires the use of hip abduction pillows as well as avoidance of leg crossing and motions that result in hip flexion greater than 90. The advantages of this approach include a significantly lower dislocation rate compared with other approaches while allowing for excellent acetabular visualization. Complementary and Alternative Medicine (CAM) for Postop Pain, prosthetic components of an artificial hip, minimally invasive surgery in hip replacement, Minimally invasive hip replacement approaches and procedures, Hip Resurfacing vs. Be aware of vessels running across this interval. In the lateral approach (also known as a Hardinge approach), the hip abductors (gluteus medius and gluteus minimus) are elevated not cut to provide access to the joint. Fat, The provocative position for hip dislocation is: hip extension, external rotation. Expose the interval between the gluteus medius and the tensor fascia lata and extend it proximally over the hip joint. The modified Hardinge anterior approach to total hip replacement is performed with you in the supine position. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). ~+=1X%TEMO1kEU. There will be small variations in the approach from surgeon to surgeon, therefore most people will described there approach as a modified Hardinge approach. You will need to detach the insertion of the gluteus minimus tendon to the anterior part of the greater trochanter. Patient positioning in case of anterolateral approach to the right hip -patient is on his left hand side, surgeon stands behind and looks down on the patients right hip which has been prepared. The same range-of-motion restrictions from the Posterior Surgical Approach (outlined above) apply to the Lateral Surgical Approach PLUS the restriction of no ACTIVE hip abduction (bringing the leg out to the side). - superior gluteal nerve enters posterior surface of this muscle and is at risk for injury (if dissection is carried too far proximally); Sleep on your surgical side when side lying. The anterolateral (Watson Jones) approach involves the detachment of about one third of the gluteus medius from the bone. - consider the Hardinge approach for patients w/ significant contracture; The lateral aspect of the greater trochanter. Choosing the optimal surgical approach can minimize these risks and therefore improve the outcome of THA. All of this gives the surgeon excellent access to the acetabulum and preserves the gluteus medius and gluteus minimus muscles (which are responsible for hip abduction when the leg moves outward). . That is completely different from sitting with the ankle stacked on top of the knee forming a figure- 4 type appearance. Exposure of the hip by anterior osteotomy of the greater trochanter. The origin of the vastus lateralis muscle should be released from the anterior inferior trochanteric region to expose the underlying hip capsule. perform anterior capsulotomy. This 1 minute video shows the precautions. The 3-in-1 commode chair offers the additional benefit of having handholds to help with standing AND can be used in the shower as a shower chair. Many surgeons now perform minimally invasive surgery in hip replacement. - prior to applying the femoral head, consider applying a trial head to be sure that stability is optimal; Advantages and complications. A simple pillow will not work as it allows portions of the leg to be unsupported which develops a fulcrum point that translates into the operated hip. Happy Total Hip Recovery Without Dislocation. Exposure of the hip by anterior osteotomy of the greater trochanter. Available from: I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. Comparison of heterotopic bone after anterolateral, transtrochanteric, and posterior approaches for total hip arthroplasty. The abductor muscle "split". Posterior hip precautions Available from: Halton Healthcare. %PDF-1.5 Leg Extension Machine (hip precautions) 10. The abductor muscle "split". Do not cross your legs. After surgery, moving the operated leg into flexion past 90 degrees, abduction past mid-line and/or internal rotation can move the femoral head against the posterior capsules incision risking dislocation or stretching out the capsule before it heals. We need to do so in a way that let us repair it in the end. We are then going to cut straight across the tendon where it inserts into the greater trochanter but leave enough cuff on both sides so as to repair it later. Surgical Exposures in Orthopaedics book 4th Edition, Campbels Operative Orthopaedics book 12th. x 9|1F:MZCqb~/5I:2 Xlm/S6|]K-EL'i! The hip is dislocated through this posterior incision in the joint capsule by the surgeon taking the patient's leg into flexion, internal rotation (pigeon-toe), and adduction (across mid-line of the body) to expose the femoral head and acetabular (hip) socket . It avoids the need for trochanteric osteotomy. Some forms of DJD include osteoarthritis (OA), post-traumatic arthritis, rheumatoid arthritis (RA), avascular necrosis (AVN) and . . Gluteus medius is a fan shaped muscle and the fibres join distally to form a tendon that inserts into the greater trochanter. 2023 Lineage Medical, Inc. All rights reserved, Hip Anterolateral Approach (Watson-Jones), Approaches | Hip Anterolateral Approach (Watson-Jones), 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, general or spinal/epidural is appropriate, generally performed in the lateral decubitus position, patient's buttock close to the edge of the table to let fat fall away from incision, 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, incise in direction of fibers, this will be more anterior as your dissect proximal, incise at the posterior border of the greater trochanter, there will be a small series of vessels in this interval, trochanteric osteotomy (shown in this illustration), distal osteotomy site is just proximal to vastus lateralis ridge, place stay suture to prevent muscle split and damage to superior gluteal nerve, nerve is 5cm proximal to the acetabular rim, incise more fasciae latae proximally to allow increased adduction and external rotation of the leg, allows access to the vastus lateralis which can be elevated to allow direct access to the entire femur, most common problem is compression neuropraxia caused by medial retraction, direct injury can occur from placing retractor into the psoas muscle, can be damaged by retractors that penetrate the psoas, confirm that anterior retractor is directly on bone, caused by trochanteric osteotomy and/or disruption of abductor mechanism, caused by denervation of the tensor fasciae by aggressive muscle split, usually occurs during dislocation (be sure to perform and adequate capsulotomy), - Hip Anterolateral Approach (Watson-Jones), Shoulder Anterior (Deltopectoral) Approach, Shoulder Lateral (Deltoid Splitting) Approach, Shoulder Arthroscopy: Indications & Approach, Anterior (Brachialis Splitting) Approach to Humerus, Posterior Approach to the Acetabulum (Kocher-Langenbeck), Extensile (extended iliofemoral) Approach to Acetabulum, Hip Direct Lateral Approach (Hardinge, Transgluteal), Hip Posterior Approach (Moore or Southern), Anteromedial Approach to Medial Malleolus and Ankle, Posteromedial Approach to Medial Malleolus, Gatellier Posterolateral Approach to Ankle, Tarsus and Ankle Kocher (Lateral) Approach, Ollier's Lateral Approach to the Hindfoot, Medial approach to MTP joint of great toe, Dorsomedial Approach to MTP Joint of Great Toe, Posterior Approach to Thoracolumbar Spine, Retroperitoneal (Anterolateral) Approach to the Lumbar Spine. The hip joint is then dislocated and the acetabular socket and femur are exposed for preparation and insertion of the prosthesis components. Damage to the superior gluteal nerve after the Hardinge approach to the hip. Retract the muscle inferiorly. The greater trochanter is reattached later by wires or cables. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. No hip flexion past 90 degrees with the Posterior Approach: The most common way that rule is broken is getting up from sitting and leaning too far forward. A hematoma requiring evacuation must be avoided. Make a T-shaped capsulotomy to expose the joint, but preserve the acetabular labrum unless a total hip arthroplasty is planned. After 6 weeks the capsule is usually well-healed but 12 weeks is usually considered the time frame for the hip capsule to fully heal. split fascia lata and retract anteriorly to expose tendon of gluteus medius. Superficial dissection. By Pil Whan Yoon 7 Videos. Additional retractors anteriorly and posteriorly will open the dissected interval. A layered closure is preferred for periprosthetic fractures. Exposure of the hip using a modified anterolateral approach. The lower leg is placed into a pocket made from sterile drapes. Incise the fascia lata over the femur and extend this incision proximally along the posterior border of the tensor fascia lata. Dr. Donaldson is dually licensed; physical therapy in 1975 and doctor of chiropractic in 1995. Dislocation after total hip arthroplasty using the anterolateral abductor split approach. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Lateral Approach Total Hip Replacement Precautions: The lateral approach to hip replacement, like the posterior approach, cuts the joint capsule in the posterior of the hip and the surgeon dislocates the femoral head through that incision to expose the femoral head and acetabular socket for preparation to receive the replacement components. Ensure you get into the car from street level, not from a curb or doorstep, Ensure the car sit is not too low, use pillow if necessary, Dont go for long car rides, stop get and walk at about every 2 hours. Required fields are marked *, This renowned classic provides unparalleled coverage of manual muscle testing, plus evaluation and treatment of faulty and painful postural conditions. No internal rotation with the Posterior Approach: The most common way that rule is broken is by pivoting on the operated leg when turning in that direction. Partial Hip Replacement. The first 6 weeks are critical to maintaining these range of motion restrictions and these restrictions will remain precautionary for the rest of life. Begin the incision 5 cm above the tip of the greater trochanter. Anterolateral approach. A subfascial drain should be considered as blood loss can be significant and periprosthetic fracture patients are at high risk of requiring anticoagulation immediately postoperatively. Enter the capsule using a longitudinal T-shaped incision. The anterior attachment of the hip capsule is next released from the anterior base of the femoral neck, and an anterior longitudinal capsulotomy is opened as necessary with a proximal transverse T-shaped incision. DTIT]Hiv_~Zd #Ke0z3U?7-3KG|~LH22R9U I2JcAvaePNmgVhDcOb't^OaLK3mTj .!JR5\bdTg?`S>8y^|\Qm/Tt(Qm &+)YRJMj'9pGL4YakEXx Z}]2 5lFJA 1I*k@v35l`zg>}aUP=jv9-vfqXR4!KNax(vqz_ 8r Sc?^bUv=hrPe]F? The anterolateral approach/ the modified hardinge approach - commonly used for hemiarthroplasty in fracture neck of femur,total hip replacement. Expose the fascia lata and iliotibial band and divide them in the line of skin incision. Wheeless' Textbook of Orthopaedics. It is just a natural instinct to bend forward and lean on the thighs when sitting on the commode. These same range-of-motions that are used to dislocate the hip at the surgery are the same range-of-motion movements that are restricted. Perhaps you are approaching or already retire and wondering how you could earn extra money in retirement.One option would be to do as I am doing.Read my article How To Generate Retirement Income: Cash In On Your Knowledge. detach fibers of gluteus medius that attach to fascia lata using . )=(5NFV~Q};a?CQjvy'"%wJNCouX{Ey}C qFBlpK"TC@W!#Fh6>`>tE@~HEy\pIgGmj.+N&'>=9ai7m14t`i.r?hE9M\(1@:rQ!]+szt8{r7~;58 R:.n[8811X_jP>fgfiF2IV'9pv]9+b*qLR__$a9R.*[@TR*GGq#}dyfOdWL7pfYc $XyEvNd!#[3|US:a;W} OXs!8fJ! Keep retractors on bone with no soft tissue under to prevent iatrogenic injury. Underneath the fascia is the muscle layer. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4536510/, https://www.ncbi.nlm.nih.gov/books/NBK537031/. Cabrera JA, Cabrera AL. Detach any fibers of the gluteus medius that attach to the deep surface of this fascia by sharp dissection. Patients undergoing THA at our institution are informed of the requirement to follow hip precautions at multiple points during their pre-operative screening, admission . Lightfoot CJ, Coole C, Sehat KR, Drummond AE. - note that if a Steinman pin as been used to retract the medius, it should be removed at this point, since it may placed signficant tension on the medius and give a false sense of hip stability; - Cautions: Over my career, I have seen several posterior approach total hip replacement dislocations, some as many as 20 years after surgery before they experienced their first dislocation. The anterior hip replacement procedure has fewer precautions. #R? g? Complications like posterior hip dislocation and infection were nil. The Hardinge approach was once the commonest approach for THR, but the issues with it are that it can damage the hip abductors, which can leave the patient with a persistent limp. The other is a very small incision in the thigh through which a special instrument is employed to work on the acetabulum (socket). Preliminary remarks. 2023 Lineage Medical, Inc. All rights reserved, Hip Direct Lateral Approach (Hardinge, Transgluteal), Approaches | Hip Direct Lateral Approach (Hardinge, Transgluteal), has lower rate of total hip prosthetic dislocations, begin 5cm proximal to tip of greater trochanter, longitudinal incision centered over tip of greater trochanter and extends down the line of the femur about 8cm, detach fibers of gluteus medius that attach to fascia lata using sharp dissection, split fibers of gluteus mediuslongitudinally starting at middle of greater trochanter, do not extend more than 3-5 cm above greater trochanter to prevent injury to, extend incison inferior through the fibers of, anterior aspect of gluteus medius from anterior greater trochanter with its underlying gluteus minimus, requires sharp dissection of muscles off bone or lifting small fleck of bone, follow dissection anteriorly along greater trochanter and onto femoral neck which leads to capsule, gluteus minimus needs to be released from anterior greater trochanter, runs between gluteus medius and minimus 3-5 cm above greater trochanter, limiting proximal incision of gluteus medius, most lateral structure in neurovascular bundle of anterior thigh, keep retractors on bone with no soft tissue under to prevent iatrogenic injury, - Hip Direct Lateral Approach (Hardinge, Transgluteal), Shoulder Anterior (Deltopectoral) Approach, Shoulder Lateral (Deltoid Splitting) Approach, Shoulder Arthroscopy: Indications & Approach, Anterior (Brachialis Splitting) Approach to Humerus, Posterior Approach to the Acetabulum (Kocher-Langenbeck), Extensile (extended iliofemoral) Approach to Acetabulum, Hip Anterolateral Approach (Watson-Jones), Hip Posterior Approach (Moore or Southern), Anteromedial Approach to Medial Malleolus and Ankle, Posteromedial Approach to Medial Malleolus, Gatellier Posterolateral Approach to Ankle, Tarsus and Ankle Kocher (Lateral) Approach, Ollier's Lateral Approach to the Hindfoot, Medial approach to MTP joint of great toe, Dorsomedial Approach to MTP Joint of Great Toe, Posterior Approach to Thoracolumbar Spine, Retroperitoneal (Anterolateral) Approach to the Lumbar Spine.