endobj The superior approach can be extended into a posterior approach if the surgeon needs more access to the femur or pelvis. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. The modified-Hardinge approach, which preserves the posterior capsule, has been shown to have the lowest rate of dislocation, even in the absence of formal postoperative hip precautions. For further exposure of the femur and placement of hardware, the vastus lateralis can be released and repaired later. Traditionally, protocols describing these restrictions and precautions require patients to sleep supine (usually with an abduction pillow in place), to use walking aids for several weeks, only to sit on high chairs and not to sit cross-legged, not to bend forward or to flex their hip joint beyond 90. Damage to the superior gluteal nerve after the Hardinge approach to the hip. The proximal part of the incision is limited by the superior gluteal nerve and vessels, crossing 3-5 cm proximal to the tip of the greater . Surgical Approaches to the Hip Joint and Its Clinical - IntechOpen This can be best done by blunt dissection. Precautions include: o Posterior Precautions: o No hip flexion >90 degrees o No hip internal rotation or adduction beyond neutral Gluteus medius is a fan shaped muscle and the fibres join distally to form a tendon that inserts into the greater trochanter. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4536510/, https://www.ncbi.nlm.nih.gov/books/NBK537031/. Modified Hardinge Approach for Total Hip Arthroplasty | VuMedi The greater trochanter at the upper end of the femur may also be cut in this approach (also referred to as an osteotomy), which greatly increases the exposure of the hip joint. Many surgeons usually use a preferred approach to the hip for routine hip operations. Exposure of the hip by anterior osteotomy of the greater trochanter. Continue developing this anterior flap, following the contour of the bone onto the femoral neck, until the anterior hip joint capsule is fully exposed. Indications: Trauma - Hemiarthroplasty THR - lower dislocation rate Video: Positioning: Supine, GT at the edge of the table (buttock muscles, and . Split the fibers of the vastus lateralis muscle overlying the lateral aspect of the base of the greater trochanter. Modified Hardinge - Anterolateral Approach to the Hip As a licensed physical therapist I have seen hundreds, if not thousands, of total hip replacement surgeries over the more than 4 decades of treating patients as a hospital-based physical therapist, outpatient physical therapy owner/operator, and for the past several years seeing total hip replacement patients in their homes just a day or two after their surgeries.
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