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THR approaches or incisions

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Josephine

Josephine

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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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Josephine

Josephine

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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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Josephine

Josephine

FORUM ADMIN, NURSE DIRECTOR
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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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