Orthopedics & Orthopedic Surgery
Area of Focus: Hip, Knee & Lower Extremity and Joint Replacement
Unlike the Roettinger modification to Watson-Jones, the crisscross total hip replacement (THR) approach requires no special table or instruments, and the skin incision is perpendicular to the interval between the glutei and tensor muscles. Surgery is completed through this interval without severing tendons or muscles.
Since 2006, 140 prospective patients had standard non-cemented THR using a crisscross approach (excluding previously exposed hips). Position the patient in lateral decubitus with the pelvis secured and flexed 20º-30º. Start the incision 2 inches inferior and posterior to ipsilateral ASIS and extend distally for 3inches. For the acetabulum exposure, place curved Hohmans on anterior and posterior walls, osteotomize the femoral neck, and ream sequentially to the desired cup implant size. For the femoral exposure, stand anterior, paralyze the patient, tilt the table posteriorly 20º-30º, extend the hip 20º-30º and externally rotate to 80º-90º, adduct with a retractor under the femoral neck and a curved retractor on the greater trochanter to protect glutei. Let the leg drop in a bag. Use a canal finder, box osteotome and subsequent broaching or reaming for final implant insertion.
Mean hospital stay was 3.9 days; rehabilitation goals of full weightbearing were met in 3-4 weeks. Three implants were undersized; one needed an insole. There was no transfusion, dislocation, deep infection, neurovascular injury, or re-operation. Surgery time averaged 15 minutes longer. The Trendelberg test was negative. A crisscross approach in THR results is a true mini-invasive approach.