cadera / hip - Active Congress.......
cadera / hip - Active Congress.......
cadera / hip - Active Congress.......
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MIÉRCOLES / WEDNESDAY<br />
126<br />
ment is as important as the type of surgical<br />
exposure used.<br />
MIS THA: POSTERIOR<br />
APPROACH<br />
D. A. Dennis, M.D.<br />
Adjunct Professor, Dept. of Biomedical<br />
Engineering, University of Tennessee<br />
Assistant Clinical Professor, University<br />
of Colorado Health Sciences Center<br />
Clinical Director, Rocky Mountain Musculoskeletal<br />
Research Laboratory<br />
Denver, Colorado, USA<br />
1. Goals of Total Hip Arthroplasty (THA)<br />
a. Restore Normal Function<br />
i. Restore Hip Biomechanics<br />
1. Offset / Leg Length<br />
b. Eliminate Disabling Pain<br />
c. Long Term Durability<br />
i. Reduced Wear<br />
ii. Long Term Fixation<br />
d. Rapid Rehabilitation<br />
i. Early Mobilization<br />
ii. Multimodal Analgesia Program<br />
1. Pre-emptive Analgesia<br />
2. Local Injection<br />
3. Peripheral Nerve Blocks<br />
iii. Limit Soft Tissue Disruption<br />
2. Minimally Invasive THA Approaches<br />
a. Anterior<br />
b. Anterolateral<br />
c. Posterior<br />
d. Two Incision Techniques<br />
i. Anterior & Transgluteal<br />
3. Minimal Invasive Posterior Approach<br />
a. Advantages<br />
i. Familiar to Most Surgeons<br />
ii. Reproducible<br />
iii. Minimizes Abductor Mechanism Damage<br />
1. Facilitates Rapid Functional Return<br />
iv. Specialized Equipment Not Required<br />
1. O.R. Tables / Positioners / Intraoperative<br />
Fluoroscopy<br />
b. Surgical Techniques<br />
i. Skin Incision<br />
1. As Long As Necessary (9-12 cm In<br />
Most)<br />
2. Flex Hip 80º<br />
3. Place Incision Parallel With Femur<br />
Beginning 1-2 cm Distal To Vastus<br />
Lateralis Tubercle and Extend<br />
Proximally<br />
a. TECHNICAL TIP: Extending Incision<br />
Distally Facilitates Acetabular Reaming<br />
Whereas Extending Proximally Eases<br />
Femoral Preparation.<br />
ii. External Rotator Release / Posterior<br />
Capsulotomy<br />
1. Incise Traversely Along Superior<br />
Border of Piriformis Then Distally<br />
Along Posterior Border of Greater<br />
Trochanter<br />
a. Preserve Quadratus Femoris<br />
b. Detached Capsule / Rotators Tagged<br />
With 5-Ethibond Suture For Later Repair<br />
c. Preserve Ischiofemoral Ligament (Aids<br />
Postoperative Stability)<br />
iii. Acetabular / Femoral Preparation /<br />
Implantation<br />
iv. Anatomic Capsular / Rotator Repair<br />
4. Clinical Results<br />
i. Data Contradictory<br />
1. Berger, et al, CORR, 2004<br />
a. Quicker Return To Normal Function<br />
b. Narcotics Discontinued By 6 Days<br />
c. No Increased Complications<br />
2. Wright, Sculco, et al, J. Arthroplasty,<br />
2004<br />
a. ↓ Length of Stay<br />
b. Slightly Higher Clinical Scores (<br />
p=0.042)<br />
c. No Increased Complications<br />
3. deBeer, et al, J. Arthroplasty, 2004<br />
a. No Differences In Operative Time,<br />
Blood Loss, Transfusion Requirements,<br />
or Length of Stay<br />
b. Increased Risk (With MIS Tech-
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