Surgical approaches to hip OA

Question 1

Surgical approaches to hip OA

Answer 1

Definitive treatment is hip replacement either by total hip (arthroplasty) or by hemiarthroplasty.

The approach is defined by relation to gluteus medius.

Posterior approach

Anterolateral approach (Modified Hardinge approach)

Anterior approach (Smith-Petersen approach)

Question 2

Explain posterior approach

Answer 2

Most common

Rehab is fast due to preservation of abductor mechnism

Greatest risk of sciatic nerve damage and dislocation though

Question 3

Explain anterolateral approach

Answer 3

Abductor mechanism is detached to allow excessive adduction and to fully expose the acetabulum.

No risk of avascular necrosis this way as superior retinacular vessels are not interuppted

Risk of damage to superior gluteal nerve as well as slower rehab

Question 4

Explain anterior approach

Answer 4

Rarely used in the UK

Only used in open washouts of infected native hips

Question 5

How long will a modern hip prosthesis last?

Answer 5

Designed to last for 15-20 years so many patients will have their prosthesis outlive them.