What Surgical Approach do you Use?
I like the posterior approach for the excellent exposure that it provides (which is critical for the positioning of the implants) and the ease of recovery for the patient. There are some who believe a trochanteric flip (Ganz osteotomy) or anterolateral approach are better for the blood supply, but we saw from Mr. Treacy’s data that there wasn’t any difference in outcomes between the posterior and anterolateral approaches. Also, the recovery from the anterolateral and trochanteric flip tend to be more difficult, with protected weight bearing and avoidance of certain movements. Finally, if the muscles that were detached during the anterolateral approach don’t heal back to the bone, then this can be a serious problem. I don’t have much experience with the anterior approach, so I can’t really comment on that.A final word is that I think there are many ways to skin a cat, and surgeons should use what they feel comfortable with. How long do you feel it takes for the bone to be fully healed, grow into the prosthesis? For the socket, I believe it takes 3 to 6 months before the bone is fully grown onto the implant. I believe the femoral bone is something that continually remodels, since it is alive. I believe that it is weaker initially after surgery, but strengthens with gradual activity, to the point that it is probably strong enough for impact activity at 6 months. What Hip Devices Do You Prefer? I still use the BHR, Conserve Plus, and Biomet Recap. I think the devices are very similar, but the BHR has the longest track record, which is very important to me. The other devices do have the benefit of more sizes than the BHR for right now (at least in the US), so there are some patients for whom they fit better.