– Landmarks: – posterior superior iliac spine: forms the superior landmark; – incision starts at the posterior 1/3 of the greater trochanter and extends proximally for 10 cm toward a point 2 fingerbreadths below the PSIS; – this will bring the incision directly over the sciatic notch and will also … Read more
– Discussion: – anesthesia considerations: – note that with spinal anesthesia, the table will be tilted reverse trendelenburg inorder to prevent high spinal (this will have the effect of predisposing for vertical cup position if note remedied; – note that leg lengthening is more common with spinal vs general; … Read more
– 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; … Read more
– See: Total Hip Replacement Menu: – IntraOperative Frx: – frx may occurr early while the attempt to dislocate hip is made; – most postoperative femoral fractures can be prevented by avoiding injury to the bone during the original THR procedure; – bone lysis from secondary aseptic loosening may significantly compromise strength of the femur … Read more
– See: Neurologic Injuries in THR: – Discussion: – sciatic nerve is palpated by rolling it under surgeon’s finger as it crosses ischial projection from posteroinferior aspect of the acetabulum; – palpate sciatic nerve as it passes superficial to obturator internus & gemelli; – sciatic … Read more
– See: Total Hip Replacement Menu: – Discussion: – natural history of DDH: – acetabular rim syndrome: – results from dysplastic hip, which stresses the labrum, resulting in labral degeneration; – hip arthroscopy and debridement in these patients may provide the patient w/ a few … Read more
– Patient Position: – ensure that patient has not rotated anteriorly, for this may allow acetabular component to be placed in retroverted position; – ensure that patient’s torso is not tilted inferiorly (as can occur from a bean bag), as this can cause reaming in an excessive … Read more
– See: Total Hip Replacement Menu: – acetabular component revision: – operative considerations for hip dyplasia – protrusio – reaming technique: – component insertion: – … Read more
– Discussion: – see native acetabular anteversion and femoral anteversion and acetabular component position – general considerations: – simple visualization of length of anterior/posterior walls gives an accurate measure of native anteversion; – references: – Femoral anteversion in THA and its lack of correlation with native acetabular anteversion. – … Read more
– See: Vascular Problems of the Upper Extremity: – Discussion: – thoracic outlet space is created by the clavicle, first rib, subclavius muscle, costoclavicular ligament, and anterior scalene muscle; – most often affects subclavian artery, vein, and lower trunk (C8 & T1) of brachial plexus; – both the subclavian artery and the brachial plexus traverse … Read more