Abstract
Over the past years there has been considerable interest, debate and controversy over the role of surgical approaches for total hip replacements. The leading role belongs to appropriate direction and anatomical structures mobilization during surgical approach. We strictly follow the paradigm that surgical approach must enable gentle handling vessels, nerves, muscles and fascias structures create good viewing of target field with possibilities of free manipulations, give opportunity for widening at any level.
This experimental study was performed to quantitatively comparesomethemostcommonlyusedsurgicalapproaches to hip joint. Kocher-Langenbeck, Smith-Petersen, Moore, direct lateral approaches were investigated on twenty men cadavers. All bodies had normal constitution, average age 60+−5 years, body weigh 75+−10 Kg, no previous surgical interventions at the hip joint area.
For named approaches wound length (cm), wound depth (cm), angle of operating action (degree), tilting of operating axis (degree), wound’s inlet square (relative units), wound’s bottom square (relative units), accessibility zone’s square (percents) were registered. Direct measure and measuring on digital images of wounds using free version of UTHSCCA Image Tools for Windows v.2 were performed. Data stored to database for further analysis.
The average angle of operating action for posterior approaches was 75+−7 degrees, for lateral approaches – 60+−8 degrees. Tilting of operating axis for all approaches was between 55–70 degrees and was in close relation of body’s position. As a rule, supine position for lateral approaches restricted tilting of operating axis to 40–45 degrees, reducing wound’s review. The wound’s inlet square to wound’s bottom square ratio that characterizes the usefulness of approach was the worst (8–12%) for Smith-Petersen and the best for Kocher-Langenbeck (16–18%) approach. This feature for direct lateral approach was 13–15%. Some tricks (wide capsule detaching, retracting the gemelli and obturator internus and the tendon of the piriformis, for example), can increase the useful square of wound’s bottom, but not more than 3–5%.The data received is slightly disappointing. The efficiency of widely using approaches is too low. The risk of nerve palsy or injury appear to be higher on the direct lateral approaches, however, there were no significant differences when comparing this risk nerve by nerve for both posterior and lateral approaches, in particular for the sciatic nerve.
One can reduce the operating trauma by using minimal invasive technique, but this approach demands special instrument sets and must be under thoroughly investigation to clarify the questions of heterotopic bone formation, hip prostheses surviving etc.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
