- positioning and prepping
- posterolateral skin incision
- incise thru iliotibial band
- split gluteus maximus
- peel back the trochanteric bursa:
- divide trochanteric bursa and sweep it posteriorly to expose vastus lateralis, short external rotators and posterior border of gluteus medius;
- this step should be performed carefully so that the surgeon can cleanly dissect the external rotators off their insertion on the greater trochanter;
- once the bursa has been swept posteriorly, the surgeon will have the proper plane to identify the sciatic nerve, and also the interval between the piriformis and medius;
- identify the sciatic nerve
- charnley retractors:
- insert Charnely retractor at the superior border of the greater trochanter;
- retract maximus posteriorly & tensor fascia anteriorly;
- ensure that the Charnely retractor has not been placed directly over the sciatic nerve;
- elevate minimus off the superior acetabular roof;
- this is facilitated by inserting a homan retractor underneath the medius and then retracting it anteriorly;
- subsequently a periosteal elevator is used to elevate the minimus;
- measure leg lengths:
- dissect the external rotators and the posterior capsule off proximal femur:
- hip dislocation: technique
- references:
- Comparison of Primary Total Hip Arthroplasties Performed with a Minimally Invasive Technique or a Standard Technique. A Prospective and Randomized Study.
- Surgical approaches for primary total hip arthroplsty. A prospective comparison of the Marcy modification of the Gibson and Watson-Jones approaches.
- The trochanteric approach to the hip for prosthetic replacement.
- The direct lateral approach to the hip for arthroplasty. Advantages and complications.
- Comparison of heterotopic bone after anterolateral, transtrochanteric, and posterior approaches for total hip arthroplasty.
- The transgluteal approach to the hip joint.
- Comparison of the transtrochanteric and posterior approaches for total hop replacement.
- Comparison of complications after transtrochanteric and posterolateral approaches for primary total hip arthroplasty.
- Comparison of Primary Total Hip Replacements Performed with a Standard Incision or a Mini-Incision.