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THR approaches or incisions

Discussion in 'The surgical procedure (hips)' started by Josephine, Jan 13, 2010.

  1. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator
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    There are three main incisions for THR, four if you include the MIS incisions!

    1. posterior - through the back of the hip
    2. anterior - through the front
    3. antero-lateral - through the side
     
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  2. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator
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    1. Posterior approach

    posterior position.JPG

    Advantages:
    ~ better approach for the surgeon who will be able to position the implants with greater ease

    Disadvantages:
    ~ more invasion of muscles, surgeon needs to get through larger muscles to get to the joint.
    ~ more blood loss
    ~ more painful, especially since patient will be partially sitting on the incision
    ~ slightly more risk of dislocation in early days
    ~ need for pain meds for slightly longer than other two approaches

    The scar will look something like this

    posterior.jpg
     
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  3. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator
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    2. anterior approach

    anterior 4.JPG

    Sometimes the patients are placed on a table like this - a Hanna table - which enables the leg to be manipulated to dislocate the joint. It also enables access for the xray machine which provides the surgeon with live xray supervision of what he is doing within the hip.

    ai55.tinypic.com_118dglg.jpg


    Here is a (very graphic) video of the procedure.
    I have added this glossary to help you understand it as the surgeon is really talking to fellow surgeons.

    aflagsforworship.co.uk_jo_pic_images_glossaryfo.jpg




    This diagram shows the difference between an antero-lateral approach (blue line) and an anterior (green line).
    [my thanks to Orthodoc for this clarification]

    aflagsforworship.co.uk_jo_pic_images_anteririr.jpg



    Advantages:
    ~ less muscles to get through to access the joint
    ~ minimal blood loss
    ~ less painful for the patient
    ~ minimal risk of dislocation in early post-op days
    ~ patient can get ambulant much more quickly
    ~ need for post op pain meds much shorter

    Disadvantages:
    ~ restricted access to joint for the surgeon
    ~ some risk of his being unable to accurately position implants
    ~ surgeons are often overly optimistic about the recovery time

    The scar will look similar to this
    anterior.jpg
     
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  4. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator
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    3. antero-lateral - also known as just lateral

    Anterolateral.gif


    lateral approach position.JPG


    Advantages:
    ~ good access to joint for surgeon
    ~ minimal blood loss
    ~ less painful for patient than posterior but more painful than anterior
    ~ moderate risk of dislocation in early post-op days
    ~ patient can ambulate more quickly


    Disadvantages:
    Approach is:
    There are natural planes between the muscles and these are carefully negotiated by blunt dissection (no cutting!) to just tease the muscle bodies apart and give access to the joint.

    ai48.tinypic.com_w1w8ia.jpg


    The blue line is the approach through the muscle layers. The only structures that are actually cut in this and the anterior approach are the capsule (pale blue line) and the muscles lying atop the capsule (grey line) called the iliofemoral ligament (though I don't think you can actually read that, sorry).

    These are the iliofemoral ligaments that are the primary structures holding the joint together.

    ai48.tinypic.com_2e6d17l.png

    The scar will look something like this

    lateral.jpg
     
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  5. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator
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    protocols on posterior and anterior approaches

    two pdfs for interest
     

    Attached Files:

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