- Will My Neck Capsule Be Preserved?
- Will I Have Stitches or Staples?
- Can I have a MIS hip resurfacing?
- Will My Neck Capsule Be Preserved?
- Incision Length by Dr. Lichtblau
- Incision Length by Dr. De Smet of Belgium
- FAQ Surgical Questions
- Surgical Approaches at Surface Hippy
- What are the important angles of components in hip resurfacing
- Surgical Approaches to Hip Resurfacing
- What surgical approach is best – posterior or anterior?
There are of course many views and opinions amongst surgeons regarding the best approach and what to preserve during the surgical approach. Failures in resurfacing which occurs due to faulty approaches and vascularity issue, do so at the 3-6 yrs mark ( slow varus collapse with loosening of femoral component ie AVN of the entire head). Hence, it is difficult to prove or disprove any concept regarding this issue with statistical proof. One needs a large number of cases followed up carefully for a long time and have an opposite approach as a control group. This would be very difficult in a clinical setting.
Therefore, the best option would be to adopt a common sense path based on some consensus that has already emerged in the resurfacing fraternity.
It is now more or less accepted that the anterior, anterolat or post approach really has no influence as regards … Read the rest
Dr. De Smet
Normally staples are closing the wound. In young patients (ladies!) and on request the wound is getting closed
When do the stitches or staples have to be removed?
Half of the stitches or staples are normally removed after 14 days. The remaining half is removed after 16 days. Depending on the individual patient, one can decide to remove the staples later on. Staples are removed with a
In case of an intracutaneous suture, one only has to cut off one end of the suture. It is not the purpose to remove the complete suture because it is resorbable.
Do you use stitches, staples or glue?
I usually use staples – lead to great looking wounds – though some patients want me to use sutures so these are done per request – we try to be accommodating – especially when it really doesn’t … Read the rest
1. If your BMI [(weight (in kg) / height (in m)) multiplied by 2] is less than 25, then the standard incision is so small that any benefit from a “mini incision” is questionable.
2. If your BMI is 25 or more (getting more obese), and your hip is stiff, the efficacy of the “mini incision” has
not been demonstrated.
Basically, if you want a small incision, you need to be thin.
What is the advantage of minimally invasive surgery?
The NCP (Neck Capsule Preserving) Approach which is increasingly being adopted by surgeons world wide was developed at ARCH by Dr. Bose. This facilitates a faster recovery due to the repair of the capsule. The vascularity of the critical regions of the head and neck is also preserved in the NCP Approach.
Dr. De Smet
Do you preserve the hip capsule during your hip resurfacing surgeries?
[Koen De Smet ANSWER/] YES AND I THINK YOU SHOULD
Saving the capsule is good with a THR because it may decrease the rate of dislocation. In regular THR it can go either way saving or not. Due to the technical needs of the resurf procedure the
capsule must be fully opened and partially removed. There is no way to do a resurf and fully preserve the capsule. This is not a problem though because the resurfs are more stable … Read the rest
7/03/08 Dr. Lichtblau of Quebec
The anterior vs. posterior debate isn’t going to be resolved by one study of electrode blood flow. Most surgeons would agree that blood flow to the femoral head (most of which comes backwards via the femoral neck) is theoretically better preserved through an anterior approach. Much of this info comes from the work of Ganz, who did a lot of cadaver dissection to prove this. Having said that, there doesn’t seem to be any evidence whatsoever that one approach or the other leads to a higher incidence of the femoral head dying after resurfacing surgery (so called ”avascular necrosis”).
McMinn and Treacy, who have together the largest series of resurfacings in the world, both use the posterior approach, and there have not been any problems seen yet. I prefer the posterior approach because I am good at it and I can perform the surgery quite
7/03/08 Dr. De Smet of Belgium
Does the length of incision influence the rehabilitation?
No! A bigger incision does not mean that there will be more damage to the muscular structures. On the contrary, if you need a bigger incision to get better exposure, the placement of the implant can be done more precisely. Even with an incision of 30 cm you are able to walk well after 24 hours.
In the resurfacing procedure the incision is longer than THR (15 – 30 cm/6-12 inch) because of technical-anatomical reasons (saving the femoral head). The length of incision has no influence in the postoperative rehabilitation.
Which approach do you use?
For the resurfacing procedure I always use the posterolateral approach for technical reasons. For a classic total hip replacement I changed after having performed 1800 procedures from lateral to posterolateral approach as well. The posterolateral approach does have many advantages:
Mr. McMinn at the the McMinn Centre
Malposition of the cup in relation to the
head in such a way that the wear patch
approaches the edge of bearing surface leads to
Cup abduction (or Inclination) is a two
dimensional assessment. Malposition in the third
dimension is represented by anteversion or
retroversion. You are right in saying that
excess anteversion leads to edge loading towards
the front of the cup. Retroversion leads to
psoas tendinitis and also anterior impingement
(where the femoral neck hits against the edge of
the cup in flexion). This leads to posterior
subluxation of the head from the cup and to edge
loading in the back portion of the cup. All of
these are detrimental to long-term survival of
the bearing. As a rule of thumb, provided there
is no femoral abnormality, the surgeon should
try to achieve around 40 degrees of cup
abduction … Read the rest
I started back in 1991 with the antero-lateral approach to the hip for resurfacing. At that time we were worried about blood supply to the femoral head and on theoretical grounds the antero-lateral approach preserved the blood
supply well. For many patients the approach was satisfactory but there were some problems. The exposure obtained in large patients was not good. This meant that heavy retraction had to be used, and heavy retraction caused trauma to muscle and other soft tissues which in turn led to heterotopic ossification. The other problem was that some patients had a permanent limp after my surgery as a result of the surgical approach. Please understand that the instruments were crude back then compared to today where newer designs of instruments would cause less tissue trauma and make the antero-lateral approach a better option. The sight of limping patients persuaded me to change my … Read the rest