Minimally Invasive Surgery in Total Hip Arthroplasty (eBook)

Title 2
Halftitle 3
Copyright 4
Dedication 5
Preface 6
Contents 8
Contributors 12
1: Introduction 13
1.1 Development of Surgery in General 13
1.1.1 Social Changes 13
1.1.2 Technological Development 14
1.2 Development of Orthopaedic Surgery 14
1.3 Surgical Approaches in Orthopaedics 15
1.4 Surgical Approaches to the Hip Joint 15
1.5 Minimally Invasive Surgery 16
1.6 Conclusions 18
1.7 Scope of This Book 18
References 18
2: Anatomy of the Hip Joint 19
2.1 Muscles Surrounding the Hip 19
2.2 Nerves in the Anatomical Vicinity of the Hip Joint 24
2.3 Femoral Nerve (Fig. .2.7.) 24
2.4 Lateral Cutaneous Nerve of the Thigh (Fig. .2.8.) 25
2.5 Superior and Inferior Gluteal Nerves (Fig. .2.9.) 26
2.6 Sciatic Nerve (Fig. .2.10.) 27
References 29
3: Complications 32
3.1 Complications 32
3.1.1 Pre- and Intra-Operative Events 32
3.1.2 Post-Operative Events 33
References 33
4: Patient Selection, Indications and Contraindications 34
4.1 Patient Selection 34
4.1.1 Examination 34
4.1.2 Indications 35
4.1.3 Contraindications 35
References 36
5: The Anterior Approach.1 37
5.1 Introduction 37
5.2 Patient Selection 38
5.2.1 Examination 38
5.2.2 Indications 38
5.2.3 Contraindications 39
5.3 Advantages 39
5.4 Disadvantages 40
5.5 Patient Positioning/OP Field 40
5.5.1 Patient Positioning 40
5.5.2 Surgical Instrumentation 41
5.5.3 Hip Prosthesis 41
5.6 Surgical Technique 42
5.6.1 Incision and Approach 42
5.6.2 Preparation of the Femoral Neck 45
5.6.3 Preparation of the Acetabulum 47
5.6.4 Preparation of Femur 49
5.6.5 Reduction 52
5.6.6 Closure 52
5.7 Post-Surgical Care and Rehabilitation 52
5.7.1 Immediate Post-Surgical Care 52
5.7.2 Physiotherapy 53
5.8 Complications 53
5.8.1 Pre- and Intra-Operative Events 53
5.8.2 Post-Operative Events 53
5.9 Personal Experience, Outcome and Success Rate 54
References 54
6: The Anterolateral Approach with the Patient in Lateral Position1 56
6.2 Patient Selection 57
6.2.1 Examination 57
6.2.2 Indications 57
6.2.3 Contraindications 57
6.3 Advantages 58
6.4 Disadvantages 59
6.5 Patient Positioning/OP Field 59
6.5.1 Patient Positioning 59
6.5.2 Surgical Instrumentation 60
6.5.3 Hip Prosthesis 60
6.6 Surgical Technique 60
6.6.1 Incision and Approach 60
6.6.2 Preparation of the Femoral Neck 62
6.6.3 Preparation of the Acetabulum 63
6.6.4 Preparation of Femur 64
6.6.5 Reduction 66
6.6.6 Closure 68
6.7 Postsurgical Care and Rehabilitation 68
6.7.1 Immediate Post Surgical Care 68
6.7.2 Physiotherapy 68
6.8 Complications 68
6.8.1 Pre-and Intraoperative Events 68
6.8.2 Postoperative Events 69
6.9 Personal Experience, Outcome and Success Rate 69
References 70
7: The Anterolateral Approach with the Patient in Supine Position 1 71
7.1 Introduction 71
7.2 Patient Selection 72
7.2.1 Examination 72
7.2.2 Indications 72
7.2.3 Contraindications 73
7.3 Advantages 73
7.4 Disadvantages 74
7.5 Patient Positioning/OP Field (Fig. 7.1) 75
7.5.1 Patient Positioning 75
7.5.2 Surgical Instrumentation 76
7.5.3 Hip Prosthesis 76
7.6 Surgical Technique 76
7.6.1 Incision and Approach 76
7.6.2 Preparation of the Femoral Neck 77
7.6.3 Preparation of the Acetabulum 81
7.6.4 Preparation of Femur 81
7.6.5 Reduction 82
7.6.6 Closure 83
7.7 Post-Surgical Care and Rehabilitation 83
7.7.1 Immediate Post-Surgical Care 83
7.7.2 Physiotherapy 83
7.8 Complications 84
7.8.1 Pre- and Intra-Operative Events 84
7.8.2 Post-Operative Events 84
7.9 Personal Experience, Outcome and Success Rate 84
References 85
8: The Posterior Approach 1 86
8.1 Introduction 86
8.2 Patient Selection 87
8.2.1 Examination 87
8.2.2 Indications 87
8.2.3 Contraindications 87
8.3 Advantages 88
8.4 Disadvantages 88
8.5 Patient Positioning/OP Field 88
8.5.1 Patient Positioning 88
8.5.2 Surgical Instrumentation 89
8.5.3 Hip Prosthesis 90
8.6 Surgical Technique 90
8.6.1 Incision and Approach 90
8.6.2 Preparation of the Femoral Neck 91
8.6.3 Preparation of the Acetabulum 93
8.6.4 Preparation of the Femur 93
8.6.5 Reduction 95
8.6.6 Closure 96
8.7 Postsurgical Care and Rehabilitation 96
8.7.1 Immediate Postsurgical Care 96
8.7.2 Physiotherapy 97
8.8 Complications 97
8.8.1 Pre- and Intra-Operative Events 97
8.8.2 Postoperative Events 97
8.9 Personal Experience, Outcome and Success Rate 98
References 98
9: Epilogue 99
9.1 Trends in Total Hip Arthroplasty 99
References 102
Index 103

"5 The Anterior Approach (p. 27-28)

Etienne Lesur

5.1 Introduction

Minimally invasive total hip arthroplasty (THA) by the anterior approach is based on a resection-reconstruction technique that was pioneered by Robert Judet in 1947 [1–3]. Judet developed the technique in post-war France, at a time when surgeons were faced with an increased number of patients presenting with femoral neck fractures.

He was able to use the experience gained from these pelvic operations in order to improve on the conventional anterior approach for hip arthroplasty, which until then had relied on larger incisions [4]. We agree with Judet in recognizing that the anterior approach had a number of important surgical advantages [1, 5]. This approach allowed for the closest access to the hip, followed by an inter-nervous plane, and maintained the muscles undisturbed.

By applying the Hueter incision procedure to the anterior approach, Judet was able to achieve excellent outcomes with regard to post-operative recovery of function and reduced levels of pain [1]. For the anterior approach, we advocate using an orthopaedic fracture table that was originally designed by Judet [1, 5].

The MIS anterior approach has been used by Lesur and co-workers since 1993 [6], and their findings are described in this chapter. Lesur [6] has based his approach on the original technique of Judet [1], and later modifications by Letournel [7]. Over time, he simplified this technique, which allows peri-operative complications to be minimised.

By taking advantage of modern developments in prosthesis design, material composition and specially designed surgical instrumentation used for implanting, Lesur (a fellow of Letournel) has succeeded in improving upon the original technique of Hueter. Lesur [6] identified structural landmarks that act as a road map into the hip. This makes the MIS anterior approach relatively easy for any surgeon who is reasonably well skilled in dissection and minimal invasive surgery. Currently, patients undergoing THA by the MIS anterior approach of Lesur [6] may expect to walk on the same day only hours after the operation, have a shorter hospital stay, and have less post-operative pain. This facilitates their rapid rehabilitation and return to daily activities."