Lateral
Approach
This is much less frequently used
incision used in total hip replacement. Like the posterior
approach, the patient is also
placed on the
side. The body is held with vertical posts and supports.
The skin is cut open on the side of the body. The muscle (gluteus
medius)
just below the skin is split. Then the vastus lateralus
muscle fibers are split. The hip is slightly flexed. The muscle
(gluteus
minimus) below is seen and the fibers are split. Muscles
from the side of the femur (greater trochanter) are detached
along the neck
of the femur. The gluteus minimus tendon insertion
is detached. Then the front of the hip capsule is seen and cut
open. The leg
is then crossed over to the front of the table. The
hip is dislocated.
From
this point on, the procedure to install the artificial hip implant
is similar to that in the Posterior Approach. The bone
and socket of the hip joint is exposed and replaced. Afterwards,
the length of the operated leg is checked against the good leg
by feeling the knee caps to make sure they are even. A tube (drain)
is placed inside the wound so that any bleeding afterwards will
exit the body. The split and detached muscles and soft tissue
are repaired with sutures. The surface skin is closed up with
metal
staples. Bandages (dressings) are placed over the wound. A wedged
shaped pillow is then placed between the legs to keep the legs
apart. The patient is turned from the side to a face up position.
The patient is moved from the operating room table and wheeled
to the recovery room. Usually, an x-ray is taken in the recovery
room to ensure that the implants are placed in the appropriate
positions.
While
this is a less common approach, the advantage is that it allows
the surgeon to place the components, especially
the
ball and stem part (femoral component) more precisely under
direct vision. It is also recommended for patients who may have
difficulty
in following the cautions in a posterior approach. However,
if
the repaired muscles and tendons do not heal, the patient
may experience ‘residual’ weakness and may affect one’s
walking posture (gait).
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