Incision Length by Dr. De Smet and Dr. Lichtblau
| Anterior Vs Posterior Incisions & Incision Length by Dr. Ethan Lichtblau, Montreal, Quebec & Dr. De Smet of Belgium |
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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: the abductors (gluteus medius muscle) responsible for normal gait remains intact, so less patients suffer from permanent abnormal gait after hip prosthesis. There is a much better view to place the components in a more correctly way (very important for revision surgery). There will be less repetitive muscle damage in revision surgery; there are fewer patients with complaints of trochanteritis (irritation of the bursa) compared to the lateral approach. The only disadvantage of the posterolateral approach is the larger incidence of dislocations in inexperienced hands / learning curve.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 fast through this exposure. Bottom line is that your surgeon should probably use the approach he/she is most comfortable with. Hope this info is of help to you. Ethan Lichtblau, MD, FRCS(C) Montreal, Quebec |