Plastic Surgery Circulatory Surgery Digestive Surgery Muscular Surgery Reproductive Surgery |
Description - Video - After Surgery There are several different incisions or approaches used to access the hip joint including the posterior (Kocher), anterolateral (Hardinge or Liverpool), double incision (yale technique) and anterior (Smith-Peterson). The posterior (Kocher) approach accesses the joint through the back, taking Piriformis and Quadratus Femoris off the femur. This approach gives excellent access to the acetabulum and preserves the hip abductors however it does have a slightly higher dislocation rate (which may be reduced with careful posterior repair.) The anterolateral approach is also commonly used for Hip replacement and for trauma replacements (hemiarthroplasties). The approach requires division of the hip abductors (Gluteus Medius and Minimus) in order to access the joint. The abductors may be lifted up by cutting of the greater trochanter and reapplying it afterwards using cables (as per Charnley), or may be divided at their tendinous portion and repaired using sutures. In contrast to the posterior approach and lateral approach, the anterior approach uses a natural interval between soft tissue to gain access to the hip joint. The interval is found between the sartorius and tensor fascia latae. The main disadvantages to the anterior approach are that it risks damage to the lateral femoral cutaneous nerve, and it is not widely available to the public because fewer surgeons have been trained in this technique. Dr. Kristaps Keggi has been a pioneer and advocate of this approach for nearly 30 years. More recently, this approach has been advocated by Zimmer. This approach is not commonly used for hip arthroplasty. The unique and innovative aspect of the yale technique is the avoidance of the muscle cut, which was necessary before and the result of which was the limitation of the walking ability for several weeks or months and a long rehabilitation. Many hip replacement patients suffer chronic pain after the surgery. Usually, X-ray and MRI can't detect any problem with the hip joint replacement. Doctors don't know the source of the pain or how to cure it. Generally, people believe that such pain is caused by the nerve damage during the replacement surgery.
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