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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
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