{"playlist":"https:\/\/content.jwplatform.com\/feeds\/IwFksVzC.json","ph":2} 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. 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. Happy Total Hip Recovery Without Dislocation. 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. 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. Transcending Aging Independently The direct lateral approach to the hip for arthroplasty. Stationary bicycle (seat high to maintain hip precautions) 11. Abductor function after total hip replacement. There will be small variations in the approach from surgeon to surgeon, therefore most people will described there approach as a modified Hardinge approach. The origin of the vastus lateralis muscle should be released from the anterior inferior trochanteric region to expose the underlying hip capsule. Total hip arthroplasty: it has lower rate of total hip prosthetic dislocations. Dr. Donaldson is dually licensed; physical therapy in 1975 and doctor of chiropractic in 1995. They have been told not to cross their legs at the knee or the ankles. Hip precautions refer to certain things that one should not do after having total hip replacement (THR) surgery .Hip precautions are a common component of standard postoperative care following a THR. The anterolateral approach to the hip, described in 1936 by Sir Watson Jones, still is in current use when implanting THA. Patient compliance with hip precautions 12 weeks following - Springer A surgical incision, approximately 6 cm in size, is made to the anterolateral side of the thigh to gain access to the hip joint. A layered closure is preferred for periprosthetic fractures. You will need to detach the muscles from the greater trochanter either by sharp dissection or by lifting off a small flake of bone. Make a T-shaped capsulotomy to expose the joint, but preserve the acetabular labrum unless a total hip arthroplasty is planned. Superior gluteal nerve runs between gluteus medius and minimus muscles 3-5 cm above greater trochanter. Accessed April 7, 2019. Copyright@orthopaedicprinciples.com. No crossing legs with the Posterior Approach: No crossing the legs is probably the most confusing instruction my patients receive.See my article on No Crossing The Legs.. Proximally, this extends into the tendinous insertion of gluteus medius and splitting fibers of vastus lateralis distally. Preliminary remarks. The direct lateral approach to the hip for arthroplasty. 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.
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