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 or detached from the femur. The approach they erroneously refer to as anterior is also known as the Harding Approach. By contradistinction the Anterior Approach
Computerized navigation has been around for a long time, in
This is what I think about computerized navigation: It is a
So, if a surgeon has no outliers, in other words if he is
Surgical Description and Early Review 200
Michael A. Jacobs, MD1,
Robin N. Goytia, MD1 and Tarun
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 vascular
supply of the femoral head as compared with the
posterior approach.… Read the rest
|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
With the NCP approach in hip resurfacing, we cut the capsule along the femoral head, so
What are the differences between the posterior and anterior surgical approaches?
Recovery is quicker with the posterior approach because no
To improve stability and reduce the incidence of dislocation
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 never does minimally invasive or never makes an attempt to reduce his incision size (within comfort levels)- the differences will show up.When one compares
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
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 far less commonly used.
All of these approaches are adapted slightly by different surgeons.
I am aware of one nonrandomized comparison study comparing the anterior … Read the rest
|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 again is undisturbed. Increasingly surgeons the world over are realizing the importance of preserving capsule over the neck of the femur in resurfacing surgery especially|
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 minimally invasive anterior approach.
Again, I would repeat that a recent prospective randomized study showed no
differences in all three approaches.
In summary, the reasons … Read the rest
There is some data indicating that navigation can improve
A bigger challenge is acetabular component positioning.
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