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Vicky's 2nd Hip
Approaches (Surgical Approaches) PDF Print E-mail

Derek McMinn on approaches:
I started back in 1991 with the antero-lateral approach to the hip for resurfacing. At that time we were worried about blood supply to the femoral head and on theoretical grounds the antero-lateral approach preserved the blood supply well. For many patients the approach was satisfactory but there were some problems. The exposure obtained in large patients was not good. This meant that heavy retraction had to be used, and heavy retraction caused trauma to muscle and other soft tissues which in turn led to heterotopic ossification. The other problem was that some patients had a permanent limp after my surgery as a result of the surgical approach. Please understand that the instruments were crude back then compared to today where newer designs of instruments would cause less tissue trauma and make the antero-lateral approach a better option. The sight of limping patients persuaded me to change my approach to the posterior approach. The theoretical objection to this approach was that it may cause more damage to the femoral head blood supply. It turns out that the problems with femoral head blood supply using the posterior approach are very rare, as you heard at the conference. The big advantage is that an excellent exposure can be obtained, giving the surgeon the best opportunity for perfect component positioning. As you heard, inaccuracy with respect to acetabular component positioning is badly tolerated and a high acetabular component inclination angle is the single biggest reason for early bearing failure following a metal on metal resurfacing. The other great advantage is that very little trauma to the soft tissues need occur with a posterior approach resurfacing. The other thing is that a mini-incision posterior approach can be done by those surgeons experienced in the resurfacing operation with good exposure and minimal tissue trauma. My unit published our mini-incision resurfacing results a few years ago, the average incision length was under 12 cm and measured component position was good. 
There are two other surgical approaches to be considered by surgeons, but for different reasons these are not reasonable at this time.

Resurfacing vs. THR By Mark Bloomfield PDF Print E-mail

The first point I want to make is I have done hundreds or thousands of total hip replacements (THR) on all sorts of people at all sorts of ages and activity levels. Some of this experience pre-dates hip resurfacing, but I still often do THR as well. There were many very happy THR patients, but quite a few with a host of problems. My patients and colleagues' patients referred to me for a second, third or more opinion! Dislocation [sometimes occurring so often further
surgery was required], infection, leg length differences and completely inexplicable pain. Another frequent problem was limping or muscle weakness as a result of using the direct lateral or Hardinge approach to the hip in an effort to avoid the higher dislocation rate associated with the posterior approach - which more rarely has muscle weakness or limp associated with it.

NCP-Neck Capsule Preservation-Approach in Hip Resurfacing, What is it? PDF Print E-mail

Dr. Su:
The NCP approach, at least the way that we mean it, is a different way to incise the capsule in order to gain access to the hip joint. Usually with THR, the capsule is detached from the femoral neck and flipped back. It is usually preserved and repaired in order to avoid dislocation.

Heterotopic Bone Growth PDF Print E-mail
What causes it?

Mainly traumatic surgery. No protection of soft tissues and too much pulling and stretching on the muscles. (BAD SURGERY) A NON posterior approach Lengthening of the leg.

Only in the minority patients are predicted to have it (bad luck).

Koen De Smet
Groin Pain PDF Print E-mail

Yes, psoas tendinitis is an important reason for groin pain in resurfacing surgery .

This is peculiar to resurfacing as the cup for resurfacing is a very large profile ie half a sphere. Nearly all THR cups are only portions ( arc) of a hemisphere.
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