Category Archives: Hip Resurfacing Surgical Approaches

Hip Resurfacing surgical approaches

Surgical Approaches for Hip Resurfacing

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Anterior, Lateral and Posterior Approach to Surgery by Talking with Docs – Dr. Zalzal and Dr. Weening

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Talking With Docs Published on July 24, 2018 – Dr. Paul Zalzal and Dr. Brad Weening discuss different surgical approaches to hip replacement surgery. There has been a lot of interest in the anterior hip approach recently. This video compares anterior approach to lateral and posterior approaches.

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General information is not medical advice
The general information provided on the Video is for informational purposes only and is not professional medical advice, … Read the rest

Anterior Approach to Surgery by Dr. Matta

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 Note by Patricia Walter:  Sometimes hip resurfacing surgeons are not specific when they are talking about the “anterior approach to surgery” since this can include the Direct Anterior Approach, the Anterolateral Approach and other variations.  The surgeons using the posterior approach often refer to the “anterior approach” incorrectly to include all types of anterior approaches. Dr. Matta has written a comprehensive explanation of the Anterior Approach to explain the misinformation often presented.

The postings on your web site by some hip resurfacing surgeons is unfortunately giving false information about the Posterior vs Anterior approach. They are referring to the Anterior Approach in relation to what is now termed lateral approach through which the abductor tendons (gluteus medius and gluteus minimus muscles) are partially severed

… Read the rest

Computer Navigation Discussion by Dr. Brooks

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Hi Pat,

Computerized navigation has been around for a long time, in
total hips, total knees, and now hip resurfacing. A lot of
surgeons, including me, have tried it out and not seen an
advantage in all but very exceptional cases. Yet other
surgeons use it on every case.

This is what I think about computerized navigation: It is a
tool which can narrow the “bell-curve” of component
position, but the curve still has some spread. That helps a
surgeon avoid “outliers”, or badly misplaced components.
Navigation does not make component position the exact same
every time, but it helps avoid those outliers. (If it was
the exact same every time there would be no bell-curve at
all.)

So, if a surgeon has no outliers,

… Read the rest

Anterolateral Approach to Hip Resurfacing by Dr. Jacobs

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Surgical Description and Early Review  200

Link

Michael A. Jacobs, MD1,
Robin N. Goytia, MD1 and Tarun
Bhargava, MD1

1 5601 Loch Raven Boulevard,
Russell Morgan Building, Suite 402, Baltimore, MD 21239

Background: Recently, metal-on-metal hip resurfacing has
enjoyed a resurgence as an alternative to hip
arthroplasty in properly selected patients. The
purpose of the present study was to report the
early results of hip resurfacing through an anterolateral
approach and to describe the technique with
modifications that have been made as experience
with the procedure has increased…

…Conclusions: The early results associated with a
new generation of hip resurfacing devices are
promising. The anterolateral approach affords the
surgeon excellent exposure with the advantage of
increased hip stability and potentially improved … Read the rest

Neck Capsule Preservation NCP Approach in Hip Resurfacing by Dr. Su and Dr. Bose

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Obtained by Freelance Patient Advocate Volunteer Vicky Marlow 8/22/08

Dr. Su’s Article

The NCP approach, at least the way that we mean it, is a different
way to incise the capsule in order to gain access to the hip joint.
Usually with THR, the capsule is detached from the femoral neck and
flipped back. It is usually preserved and repaired in order to avoid
dislocation.

With the NCP approach in hip resurfacing, we cut the capsule along the femoral head, so
the capsule along the neck is not disturbed. This preservation of the
neck capsule should help preserve important blood vessels along the
femoral neck, which may in turn preserve blood supply for the femoral
head. This will hopefully improve longevity of the resurfacing.
This

… Read the rest

Surgical Approach by Joint Replacement Institute of Los Angeles, CA

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What are the differences between the posterior and anterior surgical approaches?

Recovery is quicker with the posterior approach because no
important muscle groups are sectioned. The posterior
approach is also well-suited for patients who are large,
well muscled or who require special techniques to implant
the hip resurfacing socket.

To improve stability and reduce the incidence of dislocation
after THR, some surgeons changed from the posterior to the
anterior approach. Even a hip resurfacing procedure
technically can be performed in most individuals using an
anterior approach but this requires removal of 33% to 50% of
the abductor muscles. Even though the muscle group is
reattached, the muscles are strong and, therefore, the
reattachment may pull loose even if activities are
restricted for a prolonged period.

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Minimally Invasive Approach to Hip Resurfacing Surgery Dr. Bose 2008

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5/1/08

Yes, it is true that minimally invasive approach has been proven not to have great benefits over a conventional incision in terms of blood loss, pain , or speed of recovery in the same surgeons hands. It is only of cosmetic value.

All studies to investigate this have been done on two groups of patients in which a single surgeon employs the two approaches in the diff groups. When a surgeon who is capable of doing a minimally invasive approach does a conventional approach it is logical that the conventional technique will be only marginally bigger and therefore advantages do not show up in studies. However, if a minimally invasive approach of a surgeon is compared with a conventional approach of another surgeon who
… Read the rest

Will My Neck Capsule Be Preserved?

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Dr. Bose

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

Dr. Rubinstein

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. … Read the rest

Approaches in Hip Resurfacing by Dr. Gross

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Approaches in hip resurfacing by Dr. Gross

The path that surgeons choose to arrive at the hip joint is called the
“approach”. There are many different basic approaches used for hip resurfacing.
None has been proven to be superior to others based on valid scientific
research. Basically, I recommend that a surgeon use the method that he/she is
already most comfortable with when performing standard total hip replacement and
modify it as needed for the more complex hip resurfacing operation. My preferred
approach is the posterior. This is used in at least 70% of hip resurfacings done
worldwide. The next most common approach is the lateral (two versions:
anterior-lateral and direct-lateral). Finally the direct anterior and the Ganz
(or trochanteric, or internal dislocation) approach are … Read the rest

Posterior Approach by Dr. Bose

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The post approach which I employ is traditionally known as the muscle sparing approach and the anterior and anterolateral approaches which is very popular in the U.S and some parts of Europe are the muscle compromising approaches. The muscle here refers to the Abductor group or the muscles which lift your leg sideways and is the most important muscle of the hip. The post approach spares this completely.However some muscle have to be cut in any approach to get access to the hip and in the post approach, one cuts the short ext rotators which are flimsy , small muscles in the back of the hip. These  are stitched back. These muscles are relatively unimportant as the main ext rotator is the gluteus maximus which
… Read the rest

Anterolateral Approach to Surgery by Dr. Mont

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The choice of approach to use for resurfacing has received much attention and I believe extra “hype.” In multiple studies now published, there are no reported clinical differences in the short term and up to ten years of follow-up between anterior and posterior approaches. I believe that any approach can be used and the surgeon should use what they feel most comfortable.

Short-term differences that patients may report with either approach have to do with other factors in my opinion. I use the antero-lateral approach because it affords me easy exposure, lower dislocation risk, less chance to disrupt the blood supply of the femoral head
– among other reasons. However, I have no problem with posterior approaches and am currently working on an even more … Read the rest

Computer Navigation Discussion by Dr. Schmalzried

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Dear Pat,

There is some data indicating that navigation can improve
the accuracy of femoral component placement in hip
resurfacing.  The real issue is “compared to what?”  For an
inexperienced surgeon, navigation may help him avoid
component positioning problems that have been associated
with “the learning curve”.  However, for an experienced
surgeon, who has an established mechanical alignment system
with a high success rate – it is difficult to demonstrate an
advantage to him with a navigation system.  Further, the
registration process takes a little time – so the
cost-to-benefit ratio for the experienced surgeon in a busy O.R. is questionable.  The navigation systems are not hard
to learn to use, even for old guys like me!

A bigger challenge is acetabular component positioning.
This

… Read the rest

Surgical Approaches for Hip Resurfacing by Dr. Su

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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

… Read the rest

Computer Navigation Discussion By Dr. Gross

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Dear Pat,

Thank you for the work you do, it helps so many.

Computer aided navigation is an
interesting concept. However, there is no evidence that it
leads to better clinical outcomes and fewer failures. On the
other hand, there is ample evidence that surgeon experience
has a dramatic effect on outcomes and complications.

One way to conceptulize this is that the experienced
surgeon’s brain is a computer with much more sophisticated
“software” than a navigation computer. When a computer is
programmed, an algorithm must be created which has certain
inherent limitations. Furthermore additional significant
sources of errors are introduced by the registration of
anatomic points for the navigation computer in surgery.

My personal opinion is that navigation that is based on a
pre-operative CT

… Read the rest

Computer Navigation Discussion by Dr.De Smet

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DEAR PAT

WHAT ABOUT NAVIGATION

Today navigation is still a tool that is not easy to use and
that needs a certain learning curve as resurfacing itself
also has.

So it is not a useful tool today for resurfacing beginners,
where it should be! It would be nice if it would be a help
at the start of the learning curve.

So can somebody with experience use it or should they use
it?

It is like doing a certain approach and having experience
with it, so it feels better and confident.

Most of the experienced surgeons do feel they do not need
it. MAYBE it could help.

BUT there are some things that have to be cleared out still
today:

  • there is no correlation in

… Read the rest

The anterolateral approach

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The anterolateral approach leads to less disruption of the femoral head-neck blood supply than the posterior approach during hip resurfacing 2007

R. Steffen, MRCS, Clinical Research Fellow1; K. O’Rourke, FRCS, Consultant Orthopaedic Surgeon2; H. S. Gill, DPhil, University Research Lecturer1; and D. W. Murray, FRCS, Consultant Orthopaedic Surgeon1

1 Nuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK. 2 Cappagh National Orthopaedic Hospital, Finglas Dublin 11, Ireland.

In 12 patients, we measured the oxygen concentration in the femoral head-neck junction during hip resurfacing through the anterolateral approach. This was compared with previous measurements made for the posterior approach. For the anterolateral approach, the oxygen concentration was found to be highly
… Read the rest

Surgical Approach by Mr. Mcminn

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Surgical Approach by Mr. McMinn

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
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