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Anterolateral Mini-invasive Muscle Sparing Hip Arthroplasty: A Crisscross Approach
Sam Hakki, MD, Saint Petersburg, FL
Publisher: American Academy of Orthopaedic Surgeons
Anterolateral Mini-invasive Muscle Sparing Hip Arthroplasty: A Crisscross ApproachOrthopedics & Orthopedic Surgery

Area of Focus: Hip, Knee & Lower Extremity and Joint Replacement

Introduction:
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.

Material/Methods:
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 20-30. 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 20-30, extend the hip 20-30 and externally rotate to 80-90, 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.

Results/Discussion:
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.

VideoDisc Anterolateral Mini-invasive Muscle Sparing Hip Arthroplasty: A Crisscross Approach

$158.00  
Format NTSC Video Format
Medium DVD
ISBN 9780892037070
Copyright Year 2010
Video Length 15 Minutes
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