Surgical Approaches

Computer-Assisted Vs Conventional Mechanical Jig Technique in Hip Resurfacing Arthroplasty

Link  http://www.arthroplastyjournal.org/article/PIIS0883540307007292/abstract?rss=yes

Volume 24, Issue 3, Pages 341-350 (April 2009)

Jose Rafael E. Resubal, MD, FPOA, David A.F. Morgan, B.Sc(Med), FRACS, FAOA

Received 16 June 2007; accepted 17 December 2007. published online 15 February 2008.

Abstract
To compare the effectiveness of computer-assisted surgery (CAS) and mechanical jig technique in hip resurfacing arthroplasty, we reviewed 176 hip resurfacing arthroplasty performed in 158 patients. The initial 131 hips were resurfaced using the conventional mechanical jig technique, and the remaining 45 hips with the CAS technique. The demographic data of the patients were similar for both techniques. Follow-up radiographs taken 2 months after the surgery showed patients in the CAS technique having a significantly better alignment of the femoral component on the frontal and sagittal planes. There was no difference in the risk of implant notching on the femoral neck for both techniques. The implant sizes were similar for both techniques; thus, the amount of bone stock preserved was not technique specific.

Reprint requests: Jose Rafael E. Resubal, MD, FPOA, Suite 1, Level 8, Arnold Janssen Centre, Brisbane Private Hospital, 259 Wickham Terrace, Brisbane, Queensland 4000, Australia.

New Doctor Video Interviews on Surface Hippy Website

Meet the Hip Resurfacing Doctors and listen to them discuss Hip Resurfacing

Bloodless hip surgery at GSMCH

Link  http://www.punjabnewsline.com/content/view/9315/38/

Tuesday, 18 March 2008

CHANDIGARH: Bloodless hip surgery would be performed at the Gian Sagar Medical College and Hospital, near here, with an internationally acclaimed orthopaedic surgeon Gursharan Singh Chana visiting the hospital regularly every two months.

Disclosing this here Tuesday, Dr Sukhwinder Singh, vice-chairman of the Gian Sagar Educational and Charitable Trust, said that Dr Chana, who is settled in the United Kingdom, would visit the GSMCH every two months.

He would train orthopaedic surgeons in bloodless hip surgery for which a 15-day training course would be organized every two months.

Dr Sukhwinder Singh said that Gursharan Singh Chana, a doctor of Indian origin, would deliver a lecture on minimal invasive surgery for total hip replacement and hip resurfacing at the Gian Sagar Medical College and Hospital on March 20.

He said that Dr Chana would interact with the faculty of the GSMCH on March 20 morning and in the evening he would address orthopaedic surgeons of Patiala. On March 21, he would be interacting with orthopaedic surgeons of Chandigarh and on march 22 he would have an interactive session with orthopaedicians of Ludhiana.

Dr Sukhwinder Singh said that an internationally acclaimed orthopaedic surgeon, Dr Chana has devised a minimally invasive approach to hip joint to carry out total hip replacement and hip resurfacing. He has devised Chana reamer handle to allow accurate surgery of the hip joint.

Dr Chana is presently working as a consultant orthopaedic surgeon at the Royal Orthopaedic Hospital, NHS Trust Birmingham, since October 2002.

Dr Chana has the vast experience of carrying out the over 2500 total hip replacements, over 2000 total knee replacement, over 1500 hip resurfacing, 200 hip replacements using minimally invasive surgical approach, 200 hip resurfacings using minimally invasive hip resurfacing.

Over the last two years he has been involved in developing instrumentation and implants for hip resurfacing procedure to be carried out using a minimally invasive approach through Comis Orthopaedics, a company based in Yorkshire.

The implant is being used currently in the U.K. This implant is the only one of its kind that can be delivered using a minimally invasive approach with obvious benefits of early discharge from hospital, blood transfusion is not necessary in 95 per cent of patients and the patients tend to return to normal activities at an earlier stage compared to patients who undergo open surgery. The average incision size is 7 cm. with this approach as opposed to 20 cm. using an open approach.

Surgical Approaches for Hip Resurfacing
Peter Brooks MD
Cleveland Clinic

Most hip replacement and resurfacing surgery in the USA, about 80%, is performed through a posterior approach. About 20% of US hip surgeons prefer some variation of an anterior approach (antero-lateral, direct lateral, trans-gluteal, or true anterior). Anterior approaches are also more common in Europe and Canada.
 

In the posterior approach, the incision, dissection, and dislocation of the hip joint are all performed posteriorly (toward the buttock). The large gluteus maximus is split, and the gluteus medius and minimus muscles (hip abductors) are retracted, but not cut. A number of smaller muscles, the “short external rotators” including piriformis, obturator internus, gemelli, quadratus, and obturator externus, are cut, and the tendon of gluteus maximus may also be partially divided. With these out of the way, the posterior hip capsule is incised, and the hip is dislocated posteriorly by turning the foot toward the ceiling. The acetabulum and femoral head are then resurfaced, the muscles and capsule are repaired, and the incision closed.
 

In the direct lateral approach, (or trans-gluteal approach as it is also known), the incision is on the side of the hip, and from there the dissection proceeds towards the front of the hip joint. The hip abductors (gluteus medius and minimus) are split in the line of their fibers, peeled off the greater trochanter of the upper femur in continuity with upper fibers of the vastus lateralis, and retracted anteriorly, allowing the anterior capsule to be cut, and the hip to be dislocated anteriorly, with the foot pointing down to the floor. During closure, these muscles all tend to lie back where they belong, and since they have not been cut across their fibers, there is no tendency for their repair to pull apart. The antero-lateral approach is similar, but retracts or detaches, rather than splits, the abductors.
 

The true anterior approach can be adapted to hip resurfacing, actually better than for hip replacement, since exposure to the shaft of the femur is difficult (and not needed in resurfacing). It is not popular among surgeons who operate on adults, but is fairly common in pediatric orthopedics.

Different approaches have different issues. The posterior approach is very well known in the USA, and BHR developers Mr McMinn and Mr Treacy use it routinely as well. Theoretically it should have a higher dislocation rate, due to the fact that dislocation almost always occurs posteriorly, and this approach disrupts all the potential restraints to posterior dislocation. But dislocation after hip resurfacing is much less of a problem than it is with hip replacement, due to the very large head size. The blood supply to the femoral head stands a greater chance of damage through the posterior approach, since that is where the vessels mostly are. The important hip abductors (gluteus medius and minimus) are left completely intact.
 

The direct lateral (trans-gluteal) approach has the advantage of a lower dislocation rate, and less likelihood of damage to the blood supply of the femoral head. In addition, no muscles are actually cut across; they are just split, or teased apart in the line of their fibers, which should lead to more reliable healing. The exposure of the socket is a “straight shot”, since the acetabulum is an anteriorly facing structure. The disadvantages are that there is nonetheless surgical trauma to the abductors which, if substantial, could cause a limp. There are also reports of heterotopic ossification, although this may occur with any approach.
 

The true anterior approach can be associated with injury to a sensory nerve responsible for the side of the thigh (lateral femoral cutaneous nerve), and the location of the incision in the groin is not the cleanest part of the body. It is also by far the least commonly used of these incisions for adult hip surgery, so at least for the time being, we do not have a lot of data.
 

The main thing to keep in mind is that any of these surgical approaches can work just fine. All have been modified in many ways as surgeons find better ways to do things. The most important thing for a patient to decide is who will do their surgery, not how it will be done. The surgeon, drawing on his or her own training, experience and beliefs, will decide what works best in their hands.