The hip joint can be approached from the front of the hip (anterior approach), from the back (posterior approach), from the side (trans-trochanteric approach), from midway between front and side (antero-lateral approach), or through a two incision approach (one anterior, and one posterior).
With the side-approach the trochanter bone is cut, and later re-attached with steel wires. This was the standard for many years, but is now only occasionally used for re-operations.
THE POSTERIOR APPROACH is the one used by most surgeons. Small, unimportant tendons (short rotators) are detached to get to the hip joint, and re-attached later in the operation. Normal walking returns much sooner than with the antero-lateral approach, sometimes in less than six weeks.
The mini-incision hip replacement is an important recent development. It is used with the posterior approach. In the past the skin incision was ten or more inches long. With special new instruments, this approach is now possible through an incision as small as three inches in thin patients. In obese patients, the incision is less than half what it would otherwise have been.
The MICRO-MINI POSTERIOR APPROACH: i.e. the P.A.T.H. Technique is a revolutionary, new way to perform hip replacement through the posterior approach. IT IS THE LEAST INVASIVE OF ALL THE APROACHES. The incision can be as small as two inches in thin patients. Only one very small, insignificant muscle tendon is detached (and later re-attached). It is so minimally invasive that many patients can walk without a walker or cane within a day or two. None of the usual six-week restrictions after hip replacement are needed with this approach. Normal walking returns sooner with this approach than with any other, sometimes in as little as two weeks.Special instrumentation developed by the Wright Medical Company makes this incredible, minimally invasive operation possible. It is arguably the biggest advance in hip surgery since the development of uncemented hip replacement.
Smaller incisions mean less blood-loss. There is also less trauma to the muscles and ligaments around the hip, so there is much less pain, and an even quicker return to normal walking, and a quicker return to work. Few orthopedic surgeons have learned the posterior mini-incision, and fewer still the P.A.T/H technique. Very few can do a perfect hip replacement, with accurate leg length, through such small incisions. Dr. Huddleston routinely uses the mini-incision posterior approach, or the micro-mini posterior approach using the P.A.T.H. technique (see below).
THE ANTERO-LATERAL APPROACH, is the second most commonly used. The chance of hip dislocation is thought to be less with this approach. However, there is a trade-off. About one third of the most important hip muscle (gluteus medius) is detached from the bone, and later re-attached. This weakens it, leaving most patients with a limp, sometimes for up to a year.
IN THE ANTERIOR APPROACH the whole operation is done through a single incision in the groin. The muscles are not cut, but are spread apart. The ligaments that hold the hip together still have to be cut. The procedure is done under x-rays. The operation is risky, even in the best hands. It is very difficult to line up the femur bone through this incision, and see it clearly. There is much room for error in the placement and sizing of the femoral component, as well as in getting the leg length right.
THE TWO-INCISION APPROACH. Two 3-inch incisions are made: one in the groin, as in the anterior approach, and one over the back of the hip. The operation is difficult, and very few surgeons have been trained to do it.
Dr. Huddleston performs the operation using a posterior approach with a mini-incision, or the micro-mini P.A.T.H. technique. With either approach there is much less pain, less blood loss, and normal walking returns sooner.
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