Anatomic Considerations for the Choice of Surgical Approach for Hip Resurfacing Arthroplasty

Nork, Sean E.; Schär, Michael; Pfander, Gilles; Beck, Martín; Djonov, Valentin; Ganz, Reinhold; Leunig, Michael

doi:10.1016/j.ocl.2005.01.003

Cited by 72 publications

(32 citation statements)

References 25 publications

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“…The most commonly used approach for resurfacing surgery is the extended posterior approach [11]; this approach provides good visibility for the acetabular and femoral component preparation and implantation [13]. However, some authors report this approach leads to compromise of the femoral head and neck blood supply [8,20].…”

Section: Introductionmentioning

confidence: 99%

“…During resurfacing through the extended posterior approach, the branches of the MFCA passing along the short external rotators to the femoral head are destroyed [20]. It also is possible to use an anterolateral approach for resurfacing [13,17]; this approach appears to preserve the femoral head and neck blood supply but blood flow in the femoral head depends on intraoperative leg positioning [18], suggesting the branches of the MFCA are temporarily occluded. Ganz et al [6] advocated the trochanteric flip for preserving femoral blood supply.…”

Section: Introductionmentioning

confidence: 99%

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Femoral Oxygenation During Hip Resurfacing Through the Trochanteric Flip Approach

Steffen

Fern

Norton

et al. 2008

Clin Orthop Relat Res

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Femoral neck fracture is one of the most common complications of hip resurfacing and considered by some to be related to reduced blood flow as a consequence of the surgical approach. We measured oxygen concentration during hip resurfacing through the trochanteric flip approach (n = 15 patients) and compared this approach with previous data for the posterior and anterolateral approaches. With the trochanteric flip the average femoral oxygenation decreased during the procedure to approximately 50% of that at the start, however it recovered to starting level by the end of the procedure. Preservation of oxygenation with the trochanteric flip was similar to that observed with the anterolateral approach, but with less variation during the procedure. Both of these approaches were superior in terms of oxygenation preservation to the posterior approach which resulted in a dramatic reduction in oxygenation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Femoral Oxygenation During Hip Resurfacing Through the Trochanteric Flip Approach

Steffen

Fern

Norton

et al. 2008

Clin Orthop Relat Res

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“…Although these discussions on the true impact of surgical exposure on the risk of developing a secondary necrosis have not resulted in an unambiguous conclusion, some authors have proposed the lateral approach as a possible alternative option, while other authors [14] recommend resurfacing procedures with a careful dissection of the capsule to preserve the retinacular vessels or suggest, even for resurfacing hip arthroplasty, other experimental approaches for intracapsular surgical procedures (digastric trochanteric osteotomy, with capsule exposure proximal to piriformis muscle) [16]. This last option should increase the surgeon's awareness of experimental minimally invasive surgical exposure which could increase the risk of neurovascular damage [1].…”

Section: Discussionmentioning

confidence: 99%

Hip resurfacing: why does it fail? Early results and critical analysis of our first 60 cases

Falez

Favetti

Casella

et al. 2007

International Orthopaedics (SICO

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Resurfacing replacement represents the most conservative solution available for total arthroplasty of the hip. However, despite the excellent results reported by highly experienced surgeons, a small but not insignificant body of literature has been published on the more controversial aspects of this approach, mainly those related to the biological and mechanical vulnerability of the retained epiphysis. We report here our evaluation of most of the variables inherent to this procedure (surgical exposure, implant design, technical steps). Based on our results, we conclude that the short-term outcome is strongly related to the surgical approach and the relationship between implant design and cementing technique. Even if posterior approaches are currently widely accepted for resurfacing replacement, the ability to preserve the medial circumflex artery has been questioned, and an alternative exposure has been proposed with good results (antero-lateral, lateral and digastric trochanteric osteotomy). Moreover, a minimally invasive posterior approach could increase the risks of vascular damage. Alternatively, inner implant geometry could affect the distribution of cement over the epiphysis when other variables (direct or indirect cementing technique, viscosity) are not properly selected.

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“…As part of the procedure the intermediate fascia (not shown) that rests on gluteus medius is also incised and successively retracted posteriorly with the mass of gluteus maximus. This retains the blood supply and innervation to the anterior part of gluteus maximus as well [19]. Full extension of the hip and padded support of the foot on the instrument table so that the hip is rotated internally as far as possible help to expose the intergluteal space.…”

Section: Figurementioning

confidence: 99%

Subkapitale Korrekturosteotomie bei der Epiphyseolysis capitis femoris mittels chirurgischer Hüftluxation

et al. 2007

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From 1996 to 2005, 30 hips with a diagnosis of slipped capital femoral epiphysis were treated according to the technique described. The average follow-up time was 55 months (24-96 months). Femoral head necrosis did not occur. Distribution across sexes was well balanced. Girls were 12 years old at the time of the operation and boys were 14 years old on average. Posterior displacement was measured at 30-70 degrees. In six hips there was a so-called acute on chronic slip. Two hips required revision due to screw failure, a difficulty that was addressed by the introduction of fully threaded wires. One hip had to be revised because the fully threaded wire bent. After reoperation, shortening of maximum 1 cm was seen in these three cases. In one patient with ectopic bone formation at the anteroinferior femoral neck, internal rotation in flexion is reduced by half.

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Anatomic Considerations for the Choice of Surgical Approach for Hip Resurfacing Arthroplasty

Cited by 72 publications

References 25 publications

Femoral Oxygenation During Hip Resurfacing Through the Trochanteric Flip Approach

Femoral Oxygenation During Hip Resurfacing Through the Trochanteric Flip Approach

Hip resurfacing: why does it fail? Early results and critical analysis of our first 60 cases

Subkapitale Korrekturosteotomie bei der Epiphyseolysis capitis femoris mittels chirurgischer Hüftluxation

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