– 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
(see: Total Hip Replacement Menu) – PreOp: – Theory and Background: – Checklist for THR and Radiographs: – Initial Exposure: – positioning, prepping and antibiotics: – posterolateral skin incision: – incise thru iliotibial band: – split gluteus maximus: – The course of the superior gluteal nerve in the lateral approach to the hip; – identify the … Read more
– See: – operative considerations for hip dyplasia – reaming technique: – component insertion: – component position: – screw placement: – acetabular component revision: – bone grafting for acetabular defects: – … 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
– Discussion: – easiest method to measure leg lengths is the measure the distance from the ASIS and a marked point on the knee; – measurement is made using the cautery cord; – the thigh must be in the exact same position each time the length is measured; – steinman pin method: – separate posterior … Read more
– See: Total Hip Replacement Menu – Discussion: – most common complication in total hip arthroplasty and most common cause of component failure; – osteolysis is a time dependent process which arises from inflammatory reaction against polyethylene particulate debris; – patho-biology: – osteolysis is … Read more
– See: – radiographic templating of femoral neck cut – femoral component offset – Discussion: – femoral neck cut will influence leg length, caput collum diaphysis (CCD) angle, and offset; – base of the femoral neck (“the shoulder”) is used as a reference for appropriate level of osteotomy; – Exposure: … 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