Anterolateral approach to the hip (Watson-Jones)
approaches FMH
approaches FMH
Fichier Détails
Cartes-fiches | 7 |
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Langue | Deutsch |
Catégorie | Médecine |
Niveau | Autres |
Crée / Actualisé | 22.10.2012 / 22.10.2012 |
Attribution de licence | Pas de droit d'auteur (CC0) |
Lien de web |
https://card2brain.ch/box/anterolateral_approach_to_the_hip_watsonjones
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Intégrer |
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Indications
THR
minimally invasive approach does not improve post-op gait kinematics when compared to traditional trans-gluteal approach
hemiarthroplasty
ORIF of femoral neck fxs
synovial biopsy of hip
biopsy of femoral neck
Intermuscular / Internervous plane
Between
tensor fasciae latae (superior gluteal nerve)
gluteus medius (superior gluteal nerve)
Incision
make 15 cm straight longitudinal incision centered over the tip of the greater trochanter (crosses posterior 1/3 of trochanter before running down the shaft of the femur)
Superficial dissection
incise fat in line with incision and clear fascia lata
incise fascia
develop interval between tensor fasciae latae and gluteus medius
externally rotate the hip to put the capsule on stretch
identify origin of vastus lateralis
Deep dissection
detach abductor mechanism by one of two mechanisms
trochanteric osteotomy
partial detachment of abductor mechanism
expose anterior joint capsule
detach rectus femoris from the joint capsule to expose the anterior rim of the acetabulum
elevate part of the psoas tendon from the capsule
Perform anterior capsulotomy
dislocate hip with external rotation
Dangers
Femoral nerve
most common problem is compression neuropraxia caused by medial retraction
Femoral artery and vein
can be damaged by retractors that penetrate the psoas
Abductor limp
cause by GT osteotomy and disruption of abductor mechanism
Femoral shaft fractures
usually occurs during dislocation (be sure to perform and adequate capsulotomy)
A 67-year-old male with severe hip arthritis presents for evaluation of a total hip arthroplasty. The patient is requesting a minimally invasive Watson-Jones approach, as he has heard post-operative mobility is significantly improved compared with a trad
There is no difference in early gait kinematics between the two approaches
Despite the recent enthusiasm for minimally invasive hip surgery, there has been no proven benefit with regards to early post-operative gait kinematics when comparing the minimally invasive Watson-Jones approach with the more traditional transgluteal approach in total hip arthroplasty (THA).
The minimally invasive Watson-Jones approach involves making an incision 8cm in length from the anterior tubercle of the greater trochanter on a line running from the trochanteric crest to the anterior superior iliac spine (ASIS).The interval between the gluteus medius and the tensor fascia lata is then identified and an extra-articular exposure of the capsule can be obtained.