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General Orthopaedics

A DIRECT SUPERIOR THA: BETTER, SAFER, FASTER

Current Concepts in Joint Replacement (CCJR) – Winter 2014



Abstract

Mini-posterior technique advantages: Familiar anatomy; Widely applicable; Predictable (and thus preventable) sources of errors; Demonstrated functional advantages over the 2-incision THA in recent prospective randomised trials and in direct comparison studies

Familiar anatomy: A substantial number of surgeons routinely use the posterior approach; With careful attention to skin incision placement and leg positioning intraoperatively it is relatively easy for most surgeons to shorten the skin incision; With the addition of specialised retractors, offset reamers and offset cup and stem inserters many THA can be done with a skin incision of 10cm or less; Easily converted to standard posterior approach if intraoperative concerns arise; Formal posterior capsular repair substantially lowers historical risk of dislocation.

Widely applicable: With relatively little variation this approach can be used for a broad range of THA patients; Several variations of the mini-posterior technique exist (Sculco, Dorr, Swanson, Goldstein); Dorr technique has been used in my practice and we have studied it extensively in direct comparison studies against the 2-incision technique.