- See: Total Hip Replacement Menu: - PreOp: - Theory and Background: - Checklist for THR: and Radiographs:
- Femoral Preparation: - femoral neck resection: - entry into femoral medullary canal: - femoral reaming: - broaching: - femoral broaching for press fit stems: - Acetabulum: - acetabular exposure and preparation for reaming: - acetabular reaming: - acetabular cup insertion: - acetabular cup position: - screw insertion: - some surgeons delay insertion of acetabular screws until, a trial reduction has been carried out, so that the cup position can be changed if needed; - this is an especially prudent consideration if an anterior capsulotomy has been performed;
- Trial Reduction:
- Femoral Stem Insertion: - insertion of cementless femoral stem: - insertion of cemented femoral stem: (cementing: preparation and technique):
- Wound Closure:
- Post Operative Care: - exam: - evaluate vascular and neurological status of both legs; - assess leg lengths (based on level of malleoli) to r/o dislocation; - deep venous thrombosis - postop radiographs: - following THR in RR, x-rays must include the entire stem in two planes; - ap view: may reveal cement outside the cortex; - lateral view: may show the stem penetration of the cortex; - hip precautions: - patients need to hip limit flexion to 90 deg; - patients will require and elevated toilet seat, and instruments to help with putting on shoes and socks; - it is unclear whether patients need restricted wt bearing (see forces acting on hip joint); - references: - Hip revision with impacted morselized allografts: unrestricted wt-bearing and restricted wt-bearing have similar effect on migration. A radiostereometry analysis. - Implant migration after early weightbearing in cementless hip replacement. - postoperative dressing: - modified vaccum assisted closure: - dramatic reduction of post op wound drainage can be obtained by applying gauze-fenestrated drain-gauze dressing covered by tegaderm which is then hooked up to wall suction; - ref: Simplified wound care and earlier wound recovery without closed suction drainage in elective total hip arthroplasty. A prospective randomized trial in 100 operations - references: - The Role of Blood Cultures in the Acute Evaluation of Postoperative Fever in Arthroplasty Patients - Urinary-Bladder Management After Total Joint-Replacement Surgery. - Factors Associated with Prolonged Wound Drainage After Primary Total Hip and Knee Arthroplasty. - Postoperative Ileus After Total Joint Arthroplasty
Surgical approaches for primary THR. A prospective comparison of the Marcy modification of the Gibson and Watson-Jones approaches. The course of the superior gluteal nerve in the lateral approach to the hip; 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. R Bauer et al. Arch Orthop Trauma Surg. Vol 95. 1979 p 47-49. Comparison of the transtrochanteric and posterior approaches for THR. RP Robinson et al. CORR. Vol 147. p 143-147. 1980. 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. Total Joint Arthroplasty: When Do Fatal or Near-Fatal Complications Occur?.
