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Technical questions about operation

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Stanj

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Hi ang
Although I have already had mine a couple days ago I am curious about some aspects of the operation itself.

Many discussions describe it involving cutting a number of muscles, the number dependent on the approach. How are and where are they cut? It is hard to imagine having any muscle function if for a long if cut in the muscle tissue generally. My guess it at attachment points.

How are they reattached to allow limited walking almost immediately? Are conventional sutures used, desolving staples, ?? seems to be a major stress point.

Looking at Grey's Anatomy gives the impression that vital nerves serving thearea and below are all over the place, how is damage to these avoided or are they really clusters and away from the work site?

When fitting the cup in the socket, the conturing of the socket seeks to be critical for stability, is some sort of cutting template used or is the cavity fashioned by eye using trial and error?

Just curious.
 
Hi ang
Although I have already had mine a couple days ago I am curious about some aspects of the operation itself.

Many discussions describe it involving cutting a number of muscles, the number dependent on the approach. How are and where are they cut? It is hard to imagine having any muscle function if for a long if cut in the muscle tissue generally. My guess it at attachment points. How are they reattached to allow limited walking almost immediately? Are conventional sutures used, desolving staples, ?? seems to be a major stress point

Actually, the number of muscles involved is minimal.

In a posterior approach the muscles, specifically the gluteal muscles, are split longitudinally and held back with retractors. Only the quadratis femorus (H) is divided and this is sutured with strong but absorbent material. It's the principle reason why posterior approach patients are specifically required not to internally rotate their leg for some weeks as this muscle will be weakened and thus the possibility of dislocation exists.

[Bonesmart.org] Technical questions about operation


In an anterior approach, the muscles are also split but they are more minor and the joint is more superficial to the skin so there are less to go through.

In both approaches, muscular fibres covering the joint capsule and the capsule, are actually cut. These are firmly sutured with absorbent material.

[Bonesmart.org] Technical questions about operation



Looking at Grey's Anatomy gives the impression that vital nerves serving the area and below are all over the place, how is damage to these avoided or are they really clusters and away from the work site?

Most of these nerves are peripheral which is to say minor. They act as a kind of disseminating grid to feed the principle nerves like the sciatic and femoral nerves. However, splitting the muscles and other tissues does minimal damage to the peripheral nerves and those that are damaged will either be co-incidental or not missed in the grand scheme of things. So long as the principle nerves are undamaged they'll be fine.


When fitting the cup in the socket, the conturing of the socket seeks to be critical for stability, is some sort of cutting template used or is the cavity fashioned by eye using trial and error?

Just curious.

Contouring or reaming the acetabulum is critical and it's not! The critical part is making sure all the diseased articular cartilage is removed and the surface left is nice, clean, fresh bone. Also that the depth of bone left in the acetabular floor is neither too thin nor too thick.

To do this reaming, special dome shaped instruments with a cheese grater are used on a power tool

[Bonesmart.org] Technical questions about operation




As for cup placement, this is pretty much eyeballed.
Principally it is the pitch of the cup in the horizontal and vertical planes that is crucial and this is achieved by using a tool with a guidance rod. This gets aligned to the leg and the axis of the pelvis.

[Bonesmart.org] Technical questions about operation



Curiosity is good! No worries!
 
Wow! Thanks for the lesson, after this information I will be less concerned about stressing suture because there aren't many. I am not sure how many others are interested in this detail but it should be made into a sticky.
I really do not know the name of the approach used on me. My surgeon told me but it was more in lay terms in Russian. The incision is about 9 inches long directly the side of the hip so it could be antero-lateral or postero-lateral. When the PT comes by today I will ask her.
Thanks a lot Josephine
 
Yes, that would be the anterior approach, pretty much. Much less invasive, less painful and less complications than the posterior.

Glad you like my little presentation!
 
Josephine,
Very Informative And Mine Was Posterior. That Is Why I Am Exercising My Muscle In The Hip. I Am Assuming That Is Why I Am Still Limping At 14 Weeks. I Am Just Now Starting As Of The Last Three Weeks The Pool And The Gym Hip Friendly Exercises. I Know It Will Take Time Because I Was So Weak To Begin With. Thanks For Your Presentation. Patty
 
Westexas,
I will be having the posterior approach as well. How did you survive the hip precautions?
How long is your incision?
I do exercise a lot, but my OS saw that there is a very visable difference in the muscle size of my left and right legs. Until I startted really paying attention I did not realize how much I do not use the right leg.
Judy
 
Yes, that would be the anterior approach, pretty much. Much less invasive, less painful and less complications than the posterior.

Hi Josephine.
I just found out the aproach was Posterior on mine. The surgeon comes by everyday but we usually have current situations to discuss and only today did I think of getting a detailed description. I assumed the Anterior apporach based on the placement of the incision.

Whatever the technique, there has been little pain, no pain medications used, and today at 1 week I was taken off the walker and got my own crutches, m first ever crutches. This really sped me up, racing in hallways. But the PT wanted to step up the intensity of exercises and boy did she step them up. She really pushed me and my legs, both, were doing things they had not done in years. After 30 minutes my muscles were shaking. tried a few steps without support but that is still hard. Using one crutch on my good side worked ok.
I was told I got my last injected medication(antibiotic for a fever I had last week) and can go home Friday or Saturday. Maybe I need to go early just to get a rest from the PT. She is going to kill me!

For those wavering about doing it, like I was for a long time, my only recommendation is" DO-IT", it is not 1/10th as much pain or complexity as some say.
 
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