Why Anterior Approach for Total Hip is Popular

Creator: Dr. Mohammed Hutaif
Published: 2023-01-16

Illustration of anterior approach for total - Dr. Mohammed Hutaif

Background

Surgical approaches are anatomic dissections of tissue planes that use anatomic knowledge to limit the amount of dissection required to perform the procedure while avoiding nerve and vessel damage. A variety of surgical approaches including anterior, anterolateral, direct lateral, transtrochanteric, and posterior have been utilized for the performance of total hip arthroplasty (THA).

Each approach has advantages and disadvantages. Postoperative dislocation following the posterior approach and prolonged abductor recovery following anterolateral and direct lateral approaches are concerning. The direct anterior approach utilizes an internervous and intermuscular plane to the hip—the interval between the sartorius and tensor fascia lata.

History of the Anterior Approach

The first written description of the anterior approach comes from Carl Hueter, a German surgeon, who published Der Grundriss der Chirurgie (The Compendium of Surgery) in 1881. Marius N. Smith-Petersen (1886-1953), an American surgeon, spread the use of this approach to the English-speaking world. Sometimes, the approach is commonly referred to as the "Smith-Petersen" approach.

The anterior approach, with slight modifications, has been used to treat various conditions of the hip including developmental dysplasia, femoroacetabular fractures, impingement, and THA. However, difficulty in gaining proper access to the femoral canal initially limited its use in hip arthroplasty. In 1985, the Judet brothers described the use of an "orthopedic table" to perform THA through the anterior approach. Over the last decade, surgeons have championed its use in THA as a true muscle-sparing approach.

Patient Positioning and Set-up

The operation can be performed with or without the use of a specialized fracture table. We routinely perform the surgery without the use of the special table, and this technique will be described.

The patient is positioned supine with the pelvis squared on a standard table such that a transverse line drawn through the anterior superior iliac spines is perpendicular to the long axis of the table. The operating table should be capable of attaining a Trendelenburg position and lowering its foot-end at the level of the break.

FIG 8.1: Patient positioning on a standard operating table.

The most prominent point of the greater trochanter is positioned at the level of the break in the table, so that hip extension results when the foot-end is lowered. The contralateral leg can be positioned in abduction on a Mayo stand at the time of femoral preparation such that the operative hip can be adducted.

**Surgical Pearl:** Use of a C-arm image intensifier is optional but highly recommended. The C-arm should be draped sterile, positioned at right angles to the long axis of the operating table on the opposite side, and advanced when needed.

An elastic compression bandage is used from the foot to the mid-thigh bilaterally to minimize venous pooling. Typically, two assistants are adequate (one is mostly responsible for limb positioning at the time of femoral preparation).

Applied Anatomy and Surgical Technique

Incision & Superficial Dissection

The present-day direct anterior approach for THA utilizes only the distal part of the original Hueter or Smith-Petersen approach. Instead of entering the interval between the fascia of the tensor and sartorius muscles, the direct anterior approach involves a more lateral entry to avoid damage to the lateral femoral cutaneous nerve.

The incision is approximately 10 cm long, starting 2 cm lateral (posterior) and distal to the anterior superior iliac spine, and extended distally and laterally directly over the belly of the tensor muscle.

FIG 8.2 & 8.3: Incision marked 2 cm lateral/distal to the ASIS. The tensor fascia lata muscle is exposed after its fascia is opened. The medial fascial flap is held with an Allis forceps to protect the lateral femoral cutaneous nerve.

The subcutaneous tissue and fat are incised to expose the fascia of the tensor fascia lata muscle, which is incised in the direction of its fibers. The medial portion of the incised fascia is grasped with an Allis forceps, and blunt dissection separates the fibers of the tensor muscle from the internal aspect of its fascia. The lateral femoral cutaneous nerve is therefore protected by the medial part of the fascia.

Deep Dissection

The tensor muscle is retracted laterally and the rectus femoris is retracted medially. Blunt dissection is continued to reveal the branches of the lateral circumflex femoral vessels, which are coagulated, ligated, or transected depending on surgeon preference.

The fascial plane lateral to the rectus femoris and inferior to the tensor muscle is then entered and released all the way up to the acetabular margin. This reveals the fat pad overlying the anterior hip capsule and proximal aspect of the origin of the vastus intermedius muscle, which is excised.

FIG 8.4 & 8.5: Branches of the lateral circumflex vessels are visualized. Following vessel ligation, the fat pad overlying the anterior hip capsule is exposed.

Capsulotomy

Two cobra retractors are placed—one medial and the other lateral to the femoral neck—to expose the anterior hip capsule. The medial retractor is placed under the rectus femoris and iliocapsularis muscles. Capsulotomy or capsulectomy is then performed. We routinely perform an inverted "T-shaped" capsulotomy to raise medial and lateral flaps.

The capsulotomy starts at the anterior wall of the acetabulum (partially releasing the reflected head of the rectus femoris) and is brought down along the superior third of the neck up to the intertrochanteric line. The fibers of the vastus intermedius (inferiorly) and gluteus minimus (laterally) are protected.

FIG 8.6 & 8.7: Anterior hip capsule after fat pad removal. An inverted T-shaped capsulotomy is created and tagged with Ethibond sutures.

Acetabular Preparation

Adequate release of the superolateral capsule up to the posterior-superior aspect of the greater trochanter is performed. The medial capsule is released adequately so that the lesser trochanter can be palpated with a finger. The femoral head is extracted, and the acetabulum is exposed by placing a sharp retractor anteroinferiorly and a cobra retractor on the ischium posterior to the acetabulum.

FIG 8.8 & 8.9: Acetabular exposure using precise retractor placement, followed by fluoroscopic confirmation of cup placement.

Femoral Preparation

A special table-mounted elevator (Omni-Tract Surgical) is used for femoral preparation. The traction hook is placed around the proximal femur, just distal to the lesser trochanter. The contralateral lower-limb is placed on a padded Mayo stand in abduction, and the operative side is placed in extension, adduction, and external rotation by dropping the foot end of the table.

FIG 8.10 & 8.11: Table-mounted femoral elevator positioning. Note the hip extension achieved by lowering the foot-end of the table.

If the femur is inadequately mobilized despite releasing the posterosuperior capsule (common in muscular males), partial or complete tenotomy of the conjoint tendon and/or the piriformis may be needed. The obturator externus tendon should be preserved.

Femoral preparation is started in the standard fashion. A curved canal finder is inserted, and sequential broaching is performed. It is advisable to keep the broach handle close to the patient's abdomen to get a straight shot down the medullary canal and prevent posterior cortical perforation.

FIG 8.12 & 8.13: Conjoint tendon release at its insertion. Femoral preparation utilizing a single-offset broach handle.

Trialing and Closure

The final broach is left in place, and the trial neck and head are inserted. The hip is brought to neutral alignment and reduced. The C-arm is used to check stem sizing, positioning, restoration of leg length, and offset.

FIG 8.14 & 8.15: Fluoroscopic imaging obtained after trial reduction demonstrating sizing, offset, and manual leg-length assessment.

Once components are finalized, the wound is irrigated. The fascia of the tensor muscle is sutured first (taking care not to suture too medially to avoid lateral femoral cutaneous nerve entrapment), followed by subcuticular skin closure.

Rehabilitation

**Postoperative Freedom:** Dislocation precautions are unnecessary because posterior musculotendinous structures are either partially or completely intact. No abduction pillow or high chair is needed.

Immediate weight-bearing and activities as tolerated are permitted. Patients can walk with a walker or crutches on the day of surgery. Most patients are discharged from the hospital on postoperative day three. Patients progress to walking with a cane in about two weeks, which they gradually wean off in 4 to 6 weeks. Postoperative physical therapy requirements are minimal after 2 weeks.

Complications

Complications specific to this approach include:

Approach-Related Complications:
LFCN Neuropraxia: The most common complication is lateral femoral cutaneous nerve damage. About 40-50% of patients report transient numbness over the anterolateral thigh, which may persist in a small percentage.
Femoral Nerve Injury: Can occur due to incorrect positioning of the medial or anterior acetabular retractor.
Hematoma: Can occur if the lateral femoral circumflex vessels are not cauterized or ligated well.
Wound Healing: Problems are more likely in obese patients with a large abdominal pannus overlying the surgical site.
Access-Related Complications:
Malpositioning of components, especially placing the cup in too much anteversion, resulting in posterior impingement or anterior dislocation.
Femoral perforation may occur (usually lateral or posterior) if the true direction of the canal is not identified.
Greater trochanter fractures can occur if the femur is inadequately mobilized.
Traction Table Complications: Ankle fractures (from overzealous rotation) and pudendal nerve neuropraxia (prolonged traction against the perineal post).
Dislocation Rates: Reported in the range of 0.61% to 1.5%, usually higher during a surgeon's initial learning curve.
Heterotopic Ossification: Considered to happen secondary to muscle damage from retraction, though data is currently limited.

Advantages

A cadaver study has revealed less abductor muscle damage with the anterior approach, although there is increased potential for damage to the tensor fascia lata and rectus femoris muscles. The direct anterior approach has been compared clinically to the lateral and mini-posterior approaches in primary THA and has been found to be advantageous in terms of early functional recovery.

Biomechanical studies comparing the anterior approach to posterior and anterolateral approaches have shown no significant long-term differences, though transient benefits are noted in the first 6 weeks. It is a true intermuscular approach with minimal to no damage to the posterior hip stabilizers. Since the femoral vessels are not distorted (compared to the posterior approach), the risk of thromboembolic complications may theoretically be lower.

In summary, the anterior approach is an excellent and rewarding approach for surgeons and patients, allowing reproducible component positioning, no post-op dislocation precautions, and rapid rehabilitation.

Detailed Chapters & Topics

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102

Chapter 102 19 min

Chronic Ankle Arthritis: A Detailed Clinical Case Study & Diagnostic Approach

Explore a detailed case of severe chronic ankle arthritis in a 62-year-old male. This includes patient history, clinica…

103

Chapter 103 21 min

Pediatric Osteomyelitis: Epidemiology, Surgical Anatomy, and Clinical Approach

Pediatric osteomyelitis demands prompt evaluation. Explore its epidemiology, key pathogens like *S. aureus*, and risk f…

104

Chapter 104 17 min

Diagnostic Approach to Median Nerve Schwannoma: A Detailed Orthopedic Case Study

Explore an orthopedic case study detailing median nerve schwannoma diagnosis in a 48-year-old male. Covers clinical pre…

105

Chapter 105 18 min

Deep Posterior Thigh Liposarcoma: An Orthopedic Oncology Case Study & Diagnostic Approach

Orthopedic case study on diagnosing deep posterior thigh liposarcoma. Learn from a 62-year-old male's clinical journey …

106

Chapter 106 15 min

Acute Purulent Flexor Tenosynovitis: Clinical Presentation, Kanavel's Signs, & Diagnostic Approach – A Case Study

In-depth case study on acute purulent flexor tenosynovitis. Identify Kanavel's four cardinal signs, understand clinical…

107

Chapter 107 40 min

Exploring the Ambulatory Surgical Setting for Total Hip Replacement

Introduction As the costs of healthcare continue to rise and the burdens of hospitalization increase, both to the healt…

108

Chapter 108 24 min

Kinectiv® Stem: Modular Necks for Primary THA Success

Introduction A primary goal of successful total hip arthroplasty (THA) is to re-establish correct hip biomechanics. Thi…

109

Chapter 109 16 min

Robotics in Total Hip Arthroplasty: A New Era of Precision

Introduction and History Robotic surgery is a semiautonomous procedure performed by a robotic arm under…

110

Chapter 110 27 min

Minimizing Risks: Computer Navigation in Hip Resurfacing Arthroplasty

Introduction RESULTS OF HIP RESURFACING ARTHROPLASTY Mid-term survivorship studies of hip resurfacing arthroplasty (HRA…

111

Chapter 111 27 min

Optimizing Outcomes: Two Stage Revision for Infected Total Hip Replacement

Introduction Deep infection (Fig. 40.1) following total hip replacement is a challenging complication for both the pati…

112

Chapter 112 16 min

Expert Bone Grafting for Primary Total Hip Replacement Success

Introduction Primary total hip replacement (THR) is a highly successful operation to relieve pain from a degenerative h…

113

Chapter 113 24 min

Exploring Every Approach to the Cervical: A Surgeon's Guide

Anterior approach to the cervical ‌ spine (C3-T1) 25 Posterior approach to the cervical spine (C2-C7) 31 Posterior appr…

114

Chapter 114 19 min

Optimizing Arthroplasty in Acute Fractures: Octopus System

Introduction The acetabular fractures are the result of significant trauma. The anatomic location as well as the comple…

115

Chapter 115 21 min

Mastering Cementing Technique Femur: A Step-by-Step Guide

Introduction Cemented Total Hip Arthroplasty (THA) is an extremely successful procedure with unsurpassed success. Recen…

116

Chapter 116 16 min

Collum Femoris Preserving: Achieve Better Primary Hip Outcomes

Introduction For the possible concept of anatomical primary hip replacement various types of prosthesis have been descr…

117

Chapter 117 13 min

The Silent Hip: Achieving a Truly Silent, Pain-Free Joint

Introduction Short stem femoral implants are rapidly gaining importance because an increasing numbers of young patients…

118

Chapter 118 32 min

Mastering Soft Tissue Balancing for Optimal THR Outcomes

Introduction The soft tissue envelope that surrounds the hip acts as a constraint that prevents the femoral head from s…

119

Chapter 119 22 min

Metal on Metal Resurfacing: Enhanced Posterior Soft Tissue Repair

Introduction Metal on metal hip resurfacing (MOMHR) has regained popularity in the last decade as an alternative to tot…

120

Chapter 120 24 min

Management of Periprosthetic Fractures: An Expert Surgical Guide

Introduction Periprosthetic fractures of the acetabulum are infrequent but complex problems. The fractures may occur du…

121

Chapter 121 22 min

Optimizing Infected THA: The One Staged Approach Explained

Introduction The operative management of periprosthetic infection after total hip arthroplasty (THA) remains a challeng…

122

Chapter 122 17 min

Looking for the Ideal Hip Implant? Uncover Key Factors

Introduction The choice of prosthesis for total hip replacement has traditionally been made by the operating surgeon, b…

123

Chapter 123 42 min

Birmingham Hip Resurfacing Designer's Technique for Active Lives

Introduction In the management of end-stage hip arthritis in young patients, the primary goal of hip resurfacing is to …

124

Chapter 124 33 min

Successful Total Hip Replacement in Developmental Dysplasia

Introduction Developmental dysplasia (DDH) leads to early osteoarthritis of the hip and poses a challenge for the recon…

125

Chapter 125 14 min

Standard Trochanteric Osteotomy: Key to Complex Hip Cases

Introduction The basis of development of this chapter deals principally with the understanding of transtrochanteric a…

126

Chapter 126 23 min

Mastering Fractures After Total Hip Arthroplasty

Introduction Total hip replacement is extremely effective in relieving pain and restoring function in the diseased hip …

127

Chapter 127 7 min

Mastering the Anterolateral Approach in Minimally Invasive Hip Replacement

Introduction This chapter is meant to give an accurate description of the anterolateral approach as used in minima…

128

Chapter 128 38 min

Maximizing Durability: Tribology and Bearing for Hip Implants

I ntroduction In the science of hip replacement development, one of the key areas of research is in the field of tribol…

129

Chapter 129 13 min

Effective Arthroplasty for Salvage of Failed Hip Fixation

Background Intertrochanteric fractures of the femur are common injuries in elderly patients, and most are treated succe…

130

Chapter 130 10 min

The Modified Hardinge Approach: Key Surgical Insights

Surgical Anatomy McFarland and Osborne first described the modern lateral approach to the hip in 1954.1 This approach w…

131

Chapter 131 25 min

Avoiding Errors: Navigation in Total Hip Arthroplasty

Introduction Computer assisted orthopedic surgery is an area in which machine capability is coupled with human judgment…

132

Chapter 132 32 min

Maximize Success: Preoperative planning in primary Hip Replacement

Introduction Total hip replacement (THR) is widely considered as one of the most successful orthopedic procedures in te…

133

Chapter 133 21 min

Optimal Arthroplasty in Proximal Fractures: What You Need to Know

Introduction Hip fractures in the elderly are associated with impaired mobility, excess morbidity and mortality, and lo…

134

Chapter 134 35 min

Mastering Hip Arthroplasty: Its Evolution and Design Unveiled

Introduction Total hip replacement has been termed as “Operation of Century” as it has revolutionized the treatment of …

135

Chapter 135 13 min

Posterolateral Surgical Approaches: Achieve Optimal Hip Replacement

Introduction Total hip arthroplasty (THA) is one of the most common and successful orthopaedic procedures currently bei…

136

Chapter 136 13 min

Approaches Posterolateral Surgical: A Guide to Enhanced Hip Surgery

Surgical Approaches-Posterolateral Introduction Total hip arthroplasty (THA) is one of the most common and successf…

137

Chapter 137 20 min

Total Hip Replacement for Protrusio: Restore Your Hip Function

Introduction Protrusio acetabuli, also known as arthrokatadysis, was first described by the German pathologist Otto1 in…

138

Chapter 138 23 min

Total Hip Arthroplasty: Restoring Mobility in Juvenile Idiopathic Arthritis

Introduction Juvenile chronic arthritis was first described by George Still in 1897 to be separate from adult rheumatoi…

139

Chapter 139 66 min

Mastering Short External Rotators for Optimal Hip Surgery Results

Surgery of the Hip Primary total hip arthroplasty 239 ‌ ‌ Revision total hip arthroplasty 255 ‌ Hip resurfacing 262 ‌ H…

140

Chapter 140 18 min

Considering METHA Short Stem? Discover Bone-Preserving THA

Introduction Short stem designs offer a conservative option for total hip arthroplasty which is bone and soft tissue pr…

141

Chapter 141 25 min

THA for patients with proximal femoral deformity: Practical solutions

Introduction Total Hip Arthroplasty (THA) in the setting of deformity in the proximal femur can be a challenging propos…

142

Chapter 142 16 min

Nanos Neck Preserving THA: Minimize Trauma, Maximize Stability

Introduction Facing increasing life expectancy and numbers of young and active patients undergoing joint replacement, r…

143

Chapter 143 26 min

Navigating Early THA for Fractures of the Acetabulum

Introduction Total hip replacement is an important option in the management of sequelae following fractures of the acet…

144

Chapter 144 14 min

Percutaneous Achilles Tendon Repair: Understanding the Approach

DEFINITION Achilles tendon ruptures typically occur about 2 to 6 cm proximal to the tendon's insertion site on the calc…

145

Chapter 145 19 min

Mastering Arthrodesis of the First MTP Joint: Key Insights

DEFINITION The term hallux rigidus refers to a painful condition of the first metatarsophalangeal (MTP) joint of the gr…

146

Chapter 146 11 min

Roto-Glide: Achieve Optimal First Metatarsophalangeal Total Mobility

DEFINITION The Roto-Glide (Implants International, Cleveland, United Kingdom; distributed by Intercus, Bad Blankenburg,…

147

Chapter 147 20 min

Isolated Subtalar Arthrodesis: When & Why It's Preferred

DEFINITION An isolated subtalar arthrodesis can be used in the treatment of a myriad of different hindfoot conditions, …

148

Chapter 148 42 min

End Articular Cartilage Loss: Arthrosurface HemiCAP Resurfacing

DEFINITION Hallux rigidus is an arthritic condition of the first metatarsophalangeal (MTP) joint. It is the most common…

149

Chapter 149 40 min

Master Techniques for Cervical Fracture Reduction: Type III & More

BACKGROUND Cervical spine fractures are seen in approximately 5% of trauma patients being evaluated at level I trauma c…

150

Chapter 150 17 min

Mastering Anterior Cervical Approaches: P Tech Fig Essentials

GENERAL CONSIDERATIONS Anterior Approach (Smith-Robinson) The approach chosen depends on a number of factors, including…

151

Chapter 151 10 min

Understanding the Rami of Spinal Nerves in Posterior Approaches

ANATOMY Sreeharsha V. Nandyala Alejandro Marquez-Lara Junyoung Ahn Kern Singh Superficial landmarks enable gross determ…

152

Chapter 152 39 min

Cervical Disc Arthroplasty: Anatomy & Surgical Approach Explained

ANATOMY Familiarity with the anterior cervical anatomy is a necessity, particularly in regard to muscular, fascial, vas…

153

Chapter 153 12 min

Metatarsophalangeal Joint Arthrodesis: Key Techniques for Success

DEFINITION Arthrosis of the first metatarsophalangeal (MTP) joint is commonly seen in osteoarthritis (hallux rigidus), …

154

Chapter 154 15 min

Anterior Thoracic Approach: Precision for Challenging Thoracic Issues

DEFINITION The anterior approach can be used to access the thoracic spine for decompression, deformity correction, and …

155

Chapter 155 18 min

Vertebral Column Resection: Fixing Severe Rigid Spinal Deformity

DEFINITION Posterior vertebral column resection (VCR) entails the removal of the anterior, middle, and posterior column…

156

Chapter 156 14 min

Metatarsophalangeal Joint Hemiarthroplasty: Get Pain Relief

DEFINITION Hallux rigidus is arthritis of the first metatarsophalangeal (MTP) joint. The amount of arthritis can range …

157

Chapter 157 21 min

Lateral Interbody Fusion: Essential Anatomy for Safe Approaches

DEFINITION Lateral approach to interbody fusion Many different names including extreme lateral interbody fusion (XLIF),…

158

Chapter 158 10 min

Approaches Orthopedic B Review | Dr Hutaif General Orth -...

(SAE08AN.50) What complication is more likely following excessive medial retraction of the anterior covering structures…

159

Chapter 159 15 min

Best Treatment of Lateral Epicondylitis: Options for Lasting Relief

DEFINITION Lateral epicondylitis involves tendinosis at the origin of the common wrist extensors. It is commonly referr…

160

Chapter 160 38 min

Surgical Approaches to Shoulder & Elbow: Pearls and Pitfalls

SHOULDER APPROACHES Luke S. Austin Joseph A. Abboud Matthew L. Ramsey Gerald R. Williams, Jr. ANTERIOR APPROACH TO THE …

161

Chapter 161 22 min

Optimal Fixation of Clavicle: Intramedullary Approach Explained

DEFINITION The clavicle is one of the most commonly fractured bones. The site on the clavicle most often fractured is t…

162

Chapter 162 32 min

Optimizing Reconstruction of Sternoclavicular Dislocation

DEFINITION Sternoclavicular dislocation is one of the rarest dislocations but one most shoulder surgeons will encounter…

163

Chapter 163 13 min

Mastering Direct Lateral Exposure for Revision Total Hip Success

Introduction Adequate exposure is considered an essential part of a revision total hip replacement, equal in importance…

164

Chapter 164 25 min

Pelvic Discontinuity: Understanding Superior and Inferior Separation

DEFINITION Pelvic discontinuity occurs when there is loss of continuity between the superior and inferior aspects of th…

165

Chapter 165 22 min

Surgical Hip Dislocation Safety: The Branch of the MFCA's Vital Role

DEFINITION Femoroacetabular impingement (FAI) is a common cause of hip pain and hip osteoarthritis in the young adult. …

166

Chapter 166 23 min

Overcoming Proximal Femoral Bone Loss: Fluted Stems in Revision THA

DEFINITION A fluted femoral stem is designed to provide diaphyseal rotational stability through multiple longitudinally…

167

Chapter 167 10 min

Templating for Revision: Navigate Complex Hip Arthroplasty

Introduction Procedure 4, on templating for primary total hip arthroplasty (THA), outlined the basics of templating and…

168

Chapter 168 28 min

Which Bearing Surface Options Are Best for Your Total Hip?

DEFINITION The bearing surface in total hip arthroplasty (THA) is defined by the contacting materials that form the art…

169

Chapter 169 12 min

Femoral Stem Revision: Posterior Approach for Better Outcomes

Controversies We prefer the posterior approach, irrespective of the previous approach(s). In revision of a previous lat…

170

Chapter 170 47 min

Total Hip Arthroplasty: Journey to Preventing Complications

DEFINITION Total hip arthroplasty (THA) is successfully performed around the world for the treatment of arthritis, oste…

171

Chapter 171 8 min

Total Hip Arthroplasty: Critical Steps Prior to Surgery

DEFINITION Total hip arthroplasty (THA) is one of the most successful operations performed today. 3 This elective proce…

172

Chapter 172 49 min

Anterior FAI Relief: Mini-Open Anterior Approach Explained

DEFINITION Femoroacetabular impingement (FAI) is a mechanical hip disorder defined as abnormal abutment between the fem…

173

Chapter 173 24 min

Well-Fixed THA Revisions: Precision in the Portion of the Osteotomy

DEFINITION Well-fixed femoral and acetabular components often must be removed during revision total hip arthroplasty (T…

174

Chapter 174 8 min

Understand Augments: The Role of Metal Augments in Arthroplasty

P ITFALLS Neuropathic Charcot joints may present with large bony defects. Knee arthroplasty is fraught with complicatio…

175

Chapter 175 33 min

Special THA Techniques for Severe Deformities Around the Hip

DEFINITION Severe deformity is a congenital (acquired or iatrogenic) abnormality in the size and shape of the native ac…

176

Chapter 176 25 min

Optimizing Resection: An Overview of Surgical Approaches for Space Sarcomas

BACKGROUND The three main extracompartmental spaces of the lower extremities are the femoral triangle, the sartorial ca…

177

Chapter 177 46 min

Restore Hip Health: Pelvic Osteotomy for Acetabular Dysplasia & CEA of Less

DEFINITION This chapter's focus is the use of pelvic osteotomies for acetabular reorientation for the treatment of symp…

178

Chapter 178 16 min

Hip Reimplantation Surgery: The Solution for Infected Implants

DEFINITION Hip reimplantation refers to the insertion of another prosthesis after removal of the original, infected pro…

179

Chapter 179 12 min

Cemented Component Longevity: The Critical Margin of the Acetabulum

P ITFALLS In order to achieve longevity of the cemented acetabular component, it is important to have adequate cover of…

180

Chapter 180 12 min

Direct Lateral Hip: Optimize Exposure with Sharp Curved Hohmann

Indications The direct lateral approach can be used for primary total hip replacement in patients with advanced arthrit…

181

Chapter 181 47 min

Hip Resurfacing: The Bone-Sparing Solution around the Femoral Head

DEFINITION Hip resurfacing is a surgical procedure whereby the femoral head is preserved and a component (mostly metal)…

182

Chapter 182 26 min

Uncemented THA: Critical Soft Tissue Tension for Joint Stability

DEFINITION Total hip arthroplasty (THA) is the standard of care for symptomatic degenerative joint disease (DJD) of the…

183

Chapter 183 15 min

Revision Arthroplasty with Acetabular Bone Loss: The Antiprotrusio Cage

DEFINITION Acetabular bone deficiency may occur primarily (eg, dysplasia, inflammatory arthritis, or seronegative arthr…

184

Chapter 184 17 min

Achieving Success with Trochanteric Osteotomy Posterior for Revision

Introduction Total hip arthroplasty can provide predictable pain relief and improve function in patients with degenerat…

185

Chapter 185 9 min

Intertrochanteric Femoral Osteotomy: Indications for Hip Preservation

Indications Patient selection is crucial for the success of the intertrochanteric osteotomy. Patients should be under t…

186

Chapter 186 10 min

Targeted Ablation of Musculoskeletal Tumors: A Safer Approach

BACKGROUND Malignant tumors of the musculoskeletal system, as many other solid tumors, require a true and wide surgical…

187

Chapter 187 10 min

Templating for Primary THA: Optimize Outcomes & Avoid Pitfalls

Introduction Templating is a familiar terminology to orthopedic surgeons whether it is used preoperatively or intraoper…

188

Chapter 188 12 min

Unlock the Figure Posterior Approach to the Hip

Indications Primary hip arthroplasty Revision hip arthroplasty Treatment Options Lateral approach Anterolateral approac…

189

Chapter 189 16 min

Pelvic Metastasis Surgery: A Component of the Utilitarian Approach

BACKGROUND Metastatic tumors of the pelvis may cause pain and a major loss of function and weight-bearing capacity. Bec…

190

Chapter 190 31 min

Exeter Hip Unit: Mastering Impaction Allografting for Femoral Bone Loss

DEFINITION One of the significant challenges in hip revision surgery is the absence of satisfactory proximal femoral bo…

191

Chapter 191 17 min

Proximal Femoral Osteotomy: When This Hip-Saving Surgery Is Performed

DEFINITION Varus intertrochanteric osteotomy involves the reorientation of the proximal femur in order to improve femor…

192

Chapter 192 37 min

Resection Arthroplasty & Spacers: Optimizing Time of Reimplantation

DEFINITION Resection arthroplasty and insertion of a spacer is used for the management of chronic deep periprosthetic i…

193

Chapter 193 9 min

Master Extensile Exposure with V-Y Quadricepsplasty

DEFINITION Gaining exposure during revision total knee arthroplasty (TKA) and primary TKA for the ankylosed knee can be…

194

Chapter 194 19 min

Figure Hip Resurfacing: Who Benefits and Who Should Avoid It?

P ITFALLS Renal dysfunction: the lack of metal ion clearance by the impaired kidney may predispose these patients to th…

195

Chapter 195 34 min

Limb Salvage: New Advances in Proximal Femoral Replacement

DEFINITION Proximal femur replacement is a salvage limb-sparing surgery for nononcologic and oncologic indications that…

196

Chapter 196 45 min

Cemented Total Hip: A Successful & Evidence-Based Solution

DEFINITION For the past 50 years, cemented total hip arthroplasty (THA) has been a highly successful surgical solution …

197

Chapter 197 54 min

Hemiarthroplasty of the Hip: Indications & Types Explained

DEFINITION Femoral neck fractures are classified according to the Garden classification ( Table 1 ). 9 This classificat…

198

Chapter 198 22 min

Minimally Invasive THA: Navigating Techniques, Benefits & Pitfalls

Introduction P ITFALLS Some contraindications that can assist with patient selection generally include complicated prim…

199

Chapter 199 17 min

Extrinsic Contracture Release: Medial Over-the-Top Approach

DEFINITION Multiple techniques have been described for the release of elbow contractures. The medial approach has …

200

Chapter 200 19 min

Stop the Snap: Hip Preservation for Snapping Iliopsoas Tendon

Hip Preservation ‌ ‌ Snapping Hip/Lateral Hip DEFINITION Coxa saltans is a term popularized by Allen and various co-aut…

201

Chapter 201 23 min

Proximal Interphalangeal and Metacarpophalangeal Joint Surface Replacement Arthroplasty

DEFINITION Rheumatoid arthritis is a disorder that can affect the hands and can cause systemic symptoms of fatigue…

202

Chapter 202 15 min

Metacarpophalangeal Joint Synovectomy and Extensor Tendon Centralization in the Inflammatory Arthritis Patient

DEFINITION The finger metacarpophalangeal (MCP) joint is commonly and characteristically involved in inflammatory …

203

Chapter 203 29 min

Hip Synovial Disorders: When is Loose Body Removal Necessary?

DEFINITION Synovial-based disorders about the hip are relatively rare entities. Synovial chondromatosis and pigmented v…

204

Chapter 204 30 min

Is a Sliding Hip Screw Best for Your Femoral Neck Fracture?

n DEFINITION Femoral neck fractures occur in two patient populations. Most commonly, they happen in older osteopenic pa…

205

Chapter 205 36 min

Achieve Optimal Femoral Head Fixation with Cephalomedullary Nailing

DEFINITION Fractures of the proximal femur are usually grouped into four major types reflecting differences in the anat…

206

Chapter 206 36 min

Mastering Posterior Wall Fractures: ORIF Techniques

n DEFINITION A posterior wall fracture is one of the elementary fracture types as described by Letournel and Judet. 6 I…

207

Chapter 207 51 min

Antegrade Nailing of the Femur: Essential Techniques for Mastery

DEFINITION A femoral shaft fracture is any fracture of the femoral diaphysis from 5 cm below the lesser trochanter to w…

208

Chapter 208 33 min

ORIF for Peritrochanteric Hip Fractures: Achieve Stable Mobility

DEFINITION Peritrochanteric hip fractures are defined as extracapsular hip fractures, always involving the trochanter a…

209

Chapter 209 30 min

Unreconstructable Fractures? Explore Metallic Radial Head Arthroplasty

DEFINITION Radial head fractures are the most common fracture of the elbow and usually can be managed either nonoperati…

210

Chapter 210 17 min

Effective Repair for Peroneal Tendon Subluxation or Dislocation

DEFINITION Peroneal tendon subluxation or dislocation from the retrofibular groove is a rare cause of ankle pain and di…

211

Chapter 211 19 min

Mastering Posterior Plateau Fractures via Direct Posterior Approaches

k DEFINITION A direct approach with the patient in a prone position to the posterior aspect of the tibial plateau for r…

212

Chapter 212 20 min

Proximal Interphalangeal and Metacarpophalangeal Joint Silicone Implant Arthroplasty

DEFINITION Arthritis of the metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joints may cause pain, def…

213

Chapter 213 36 min

When is Arthroscopic Partial Meniscectomy the Right Solution?

DEFINITION Irreparable meniscal tears are those for which no healing response is possible. This may include all or part…

214

Chapter 214 50 min

Repairing Distal Femur Fractures: Open Reduction & Internal Fixation

DEFINITION Distal femur fractures are difficult, complex injuries that can result in devastating outcomes. The distal p…

215

Chapter 215 24 min

Mastering Fixation of Periprosthetic Fractures of the Femur

DEFINITION Periprosthetic fractures about a total hip arthroplasty are fractures which occur in the femur or acetabulum…

216

Chapter 216 32 min

Retrograde Femoral Nailing: Anatomy, Pathogenesis, Diagnosis, and Surgical Considerations

Explore retrograde femoral nailing, defining techniques with distal intercondylar entry. Understand critical anatomy, f…

217

Chapter 217 51 min

Fixing Posterior Pelvic Ring Instability: Sacrum & SI Joint ORIF

DEFINITION Pelvic fractures are serious injuries associated with a diverse assortment of morbidities and mortality rate…

218

Chapter 218 37 min

Emergency Fixation of the Pelvis: Control Bleeding & Restore Stability

DEFINITION Pelvic instability is defined as inability of the pelvis to assume physiologic loads without displacement an…

219

Chapter 219 21 min

Open and Arthroscopic Radial Styloidectomy

DEFINITION Arthritis between the radial styloid and the distal aspect of the scaphoid can lead to pain, weakness o…

220

Chapter 220 18 min

Ulnohumeral (Outerbridge-Kashiwagi) Arthroplasty

DEFINITION Primary osteoarthritis of the elbow is a relatively uncommon but disabling disorder that affects mostly…

221

Chapter 221 30 min

FAI & Hip Pain: The Crucial Center Edge Angle Explained

DEFINITION Femoroacetabular impingement (FAI) is the result of abnormal contact between the proximal femur and the acet…

222

Chapter 222 16 min

Heal Your Superior Labral Anterior Tear: Arthroscopic Treatment Guide

Arthroscopic Treatment of Superior Labral Anterior Posterior (SLAP) Tears DEFINITION Superior labral anterior posterior…

223

Chapter 223 30 min

Subscapularis Tears: Mastering the Optimal Angle of Approach

Arthroscopic Treatment of Subscapularis Tears, Including Subcoracoid Impingement DEFINITION A subscapularis tendon tear…

224

Chapter 224 10 min

Arthroscopic Fix for Valgus Extension Overload: Get Back in the Game

Arthroscopic Treatment of Valgus Extension Overload DEFINITION Valgus extension overload of the elbow is commonly seen …

225

Chapter 225 11 min

Arthroscopic Release of Nerve: Find Lasting Relief from Entrapment

Arthroscopic Release of Nerve Entrapment DEFINITION Suprascapular nerve entrapment may result from constriction within …

226

Chapter 226 27 min

Dislocations and Chronic Volar Instability of the Thumb Metacarpophalangeal Joint

Dislocations and Chronic Volar Instability of the Thumb Metacarpophalangeal Joint DEFINITIO Disruption of the r…

227

Chapter 227 25 min

Find Relief: Arthroscopic Subacromial Decompression for Impingement

Arthroscopic Treatment of Subacromial Impingement DEFINITION Impingement syndrome was originally described by Neer 20 i…

228

Chapter 228 31 min

Arthroscopic Treatment of Chondral Injuries and Osteochondritis Dissecans

Arthroscopic Treatment of Chondral Injuries and Osteochondritis Dissecans ## DEFINITION Osteochondritis dissec…

229

Chapter 229 49 min

Relieve FAI Pain: Realigning the Femoral Head Center for Lasting Relief

Treatment of Anterior Femoroacetabular Impingement through Mini-Open Anterior Approach DEFINITION Femoroacetabular impi…

230

Chapter 230 24 min

Surgical Approaches to the Elbow

Surgical Approaches to the Elbow ## ELBOW APPROACHES Luke S. Austin Joseph A. Abboud Matthew L. Ramsey Gerald …

231

Chapter 231 27 min

Anatomy and Surgical Approaches of the Forearm, Wrist, and Hand

Anatomy and Surgical Approaches of the Forearm, Wrist, and Hand Definition Safe surgical dissection and exposur…

232

Chapter 232 26 min

Triple Innominate Osteotomy: Restoring Hip Coverage & Stability

Triple Innominate Osteotomy DEFINITION Triple innominate osteotomy (TIO) is a surgical procedure that includes osteotom…

233

Chapter 233 15 min

Salter Innominate Osteotomy: Correcting Developmental Hip Dysplasia

Innominate Osteotomy of Salter DEFINITION The Salter innominate osteotomy is commonly performed in conjunction with an …

234

Chapter 234 57 min

Surgical Access: Mastering the Tibia's Surface & Fibula Approaches

APPROACHES TO THE The Tibia and Fibula The Tibia and Fibula Anterolateral Approach to the Lateral Tibial Plateau Poster…

235

Chapter 235 126 min

Essential Surgical Approaches: Uncover Every Aspect of the Wrist

APPROACHES TO THE The Wrist and Hand The Wrist and Hand Dorsal Approach to the Wrist Applied Surgical Anatomy of the Do…

236

Chapter 236 93 min

Optimized Approaches to the Dorsum of the Foot & Ankle

APPROACHES TO The Foot and Ankle Twelve The Foot and Ankle Ankle and Hindfoot Anterior Approach to the Ankle Anterior a…

237

Chapter 237 16 min

Surgical Dislocation: Optimizing Femoral Headneck Offset for FAI

Surgical Dislocation of the Hip DEFINITION Surgical dislocation of the hip can be done safely to treat a number of cond…

238

Chapter 238 53 min

Mastering Elbow Approaches: Applied Surgical Anatomy for Precision

APPROACHES TO THE ELBOW The Elbow Posterior Approach to the Elbow with Olecranon Osteotomy Posterior Approach to the El…

239

Chapter 239 19 min

The Medial Open Reduction Approach: Keys to Success

Medial Approach for Open Reduction of a Developmentally Dislocated Hip DEFINITION Developmental dislocation of the hip …

240

Chapter 240 17 min

Chiari Medial Displacement: Relief for Unstable & Painful Hips

Chiari Medial Displacement Osteotomy of the Pelvis DEFINITION The Chiari osteotomy is primarily a “salvage” osteotomy f…

241

Chapter 241 57 min

Mastering Approaches to the Upper Third of the Radius

APPROACHES TO THE FOREARM The Forearm Anterior Approach to the Radius Applied Surgical Anatomy of the Anterior Compartm…

242

Chapter 242 27 min

Triple Innominate Osteotomy: Advanced Hip Dysplasia Correction

Triple Innominate Osteotomy DEFINITION Triple innominate osteotomy (TIO) is a surgical procedure that includes osteotom…

243

Chapter 243 119 min

Approach to the Lumbar Spine: Mastering Techniques & Anatomy

Approaches to the spine Six The Spine Lumbar Spine Posterior Approach to the Lumbar Spine Minimally Invasive—Posterior …

244

Chapter 244 60 min

Pelvis & Acetabulum Approaches: Unlocking the Posterior Superior Iliac

APPROACHES TO THE Pelvis and Acetabulum Pelvis and Acetabulum Anterior Approach to the Iliac Crest for Bone Graft Poste…

245

Chapter 245 52 min

Optimal Femoral Approaches: Mastering the Lateral Intermuscular Septum

Approaches to the Femur The Femur Lateral Approach Posterolateral Approach Anteromedial Approach to the Distal Two-thir…

246

Chapter 246 24 min

Mastering Pemberton and Dega Osteotomies for Hip Dysplasia

Pericapsular Osteotomies of Pemberton and Dega r DEFINITION The Pemberton 7 ( FIG 1 ) and Dega 1 , 2 ( FIG 2 ) osteotom…

247

Chapter 247 20 min

Valgus Osteotomy of the Proximal Femur: Solutions for Hip Health

Valgus Osteotomy of the Proximal Femur DEFINITION Valgus osteotomy of the proximal femur can be performed for a number …

248

Chapter 248 94 min

Essential Guide: Mastering Every Approach to the Shoulder

APPROACHES TO THE SHOULDER One The Shoulder Anterior Approach to the Clavicl e Anterior Approach to the Shoulder Joint …

249

Chapter 249 77 min

Mastering Knee Approaches: Spotlight on Superficial Medial Ligament

APPROACHES TO THE KNEE Ten The Knee Arthroscopic Approaches to the Kne e Arthroscopic Exploration of the Kne e Medial P…

250

Chapter 250 50 min

Mastering the Approach to the Distal Humerus: Safety & Skills

APPROACHES TO THE HUMERUS Two The Humerus Anterior Approach to the Humeral Shaft Minimally Invasive Anterior Approach t…

251

Chapter 251 18 min

Column Resection for Severe Deformity: The All-Posterior Approach

Vertebral Column Resection for Severe Rigid Spinal Deformity through an All Posterior Approach DEFINITION Posterior ver…

252

Chapter 252 25 min

Mastering Anterior Open Reduction for Developmentally Dislocated Hip

Anterior Approach for Open Reduction of the Developmentally Dislocated Hip DEFINITION Developmental dysplasia or disloc…

253

Chapter 253 17 min

Kyphectomy in Spina: Preventing Life-Threatening Complications

Kyphectomy in Spina Bifida DEFINITION Kyphosis in the patient with myelomeningocele can occur at the thoracolumbar junc…

254

Chapter 254 21 min

Rib to Pelvis VEPTR: Growth-Sparing Scoliosis Treatment

Rib to Pelvis Vertical Expandable Prosthetic Titanium Rib Insertion to Manage Neuromuscular Scoliosis DEFINITION Vertic…

255

Chapter 255 39 min

Addressing Cervical Spine Instability with Posterior Arthrodesis

Posterior Cervical Arthrodeses: Occiput-C2 and C1-C2 DEFINITION The occipitocervical articulation is formed by the occi…

256

Chapter 256 25 min

Anterior Interbody Arthrodesis for Scoliosis: What You Need to Know

Anterior Interbody Arthrodesis with Instrumentation for Scoliosis DEFINITION Thoracic scoliosis and thoracolumbar-lumba…

257

Chapter 257 14 min

Effective Proximal Femoral Varus Osteotomy for Hip Stability

Proximal Femoral Varus Osteotomy Using a 90-Degree Blade Plate DEFINITION Proximal femoral varus osteotomy can be usefu…

258

Chapter 258 15 min

Adductor and Iliopsoas Release: End Hip Flexor Contractures

Adductor and Iliopsoas Release DEFINITION Psoas and adductor contractures are most common in cerebral palsy but can occ…

259

Chapter 259 10 min

Treat Spastic Hip Disease: Hamstring & Adductor Lengthening

Proximal Hamstring and Adductor Lengthening DEFINITION Proximal hamstring lengthenings are primarily performed in the t…

260

Chapter 260 22 min

Arthroscopic Drilling & Fixation for Effective OCD Treatment

Arthroscopic Drilling and Fixation of Osteochondritis Dissecans DEFINITION Osteochondritis dissecans (OCD) is described…

261

Chapter 261 50 min

Mastering Fixation of the Distal Femur: Avoiding Complex Outcomes

Chapter 29 Open Reduction and Internal Fixation of the Distal Femur Animesh Agarwal DEFINITION Distal femur fractures a…

262

Chapter 262 24 min

Bernese PAO: Mastering Hip Stability Through False Profile View

Chapter 75 Bernese Periacetabular Osteotomy Travis H. Matheney and Michael B. Millis DEFINITION Hip dysplasia is the mo…

263

Chapter 263 24 min

Hip Anterior Approach: Mastering Open Reduction for DDH

Chapter 67 ‌ Anterior Approach for Open Reduction of the Developmentally Dislocated Hip Richard M. Schwend DEFINITION D…

264

Chapter 264 25 min

Mastering Anterior Interbody Arthrodesis with Instrumentation for Scoliosis

Chapter 59 Anterior Interbody Arthrodesis With Instrumentation for Scoliosis Daniel J. Sucato DEFINITION Thoracic scoli…

265

Chapter 265 19 min

Pelvis Chiari Medial Osteotomy: Salvaging Dysplastic Hips

Chapter 74 Chiari Medial Displacement Osteotomy of the Pelvis Travis H. Matheney and Brian Snyder DEFINITION The Chiari…

266

Chapter 266 14 min

Medial Femoral Circumflex Artery: Critical to Safe Hip Dislocation

Chapter 76 Surgical Dislocation of the Hip John Frino and Young-Jo Kim DEFINITION Surgical dislocation of the hip can b…

267

Chapter 267 28 min

Cervical Fusion: The Line is Drawn for Lasting Stability

Chapter 55 Posterior Cervical Arthrodeses: Occiput–C2 and C1–C2 John P. Dormans, Gokce Mik, and Purushottam A. Gholve D…

268

Chapter 268 24 min

Hip Dysplasia: Inner & Outer Acetabular Reshaping with Pemberton & Dega

Chapter 71 Pericapsular Osteotomies of Pemberton and Dega Tim Schrader and J. Anthony Gonzales, Jr. DEFINITION The Pemb…

269

Chapter 269 16 min

Scoliosis Surgery: Posterior Approach for Curves Greater Than Degrees

Chapter 56 Posterior Exposure of the Thoracic and Lumbar Spine James T. Guille and Reginald S. Fayssoux DEFINITION Scol…

270

Chapter 270 17 min

Safe Medial Approach for DDH: Guarding the Medial Femoral Circumflex Artery

Chapter 68 Medial Approach for Open Reduction of a Developmentally Dislocated Hip Lori A. Karol and Jeffrey E. Martus D…

271

Chapter 271 15 min

Restore Hip Health: Valgus Osteotomy for Developmental Coxa Vara

Chapter 77 Valgus Osteotomy for Developmental Coxa Vara Michael B. Millis and Joshua A. Strassberg DEFINITION Coxa vara…

272

Chapter 272 10 min

Realignment for Severe Slipped Capital Femoral Epiphysis Deformity

Chapter 80 Flexion Intertrochanteric Osteotomy for Severe Slipped Capital Femoral Epiphysis Young-Jo Kim and John Frino…

273

Chapter 273 15 min

Mastering Posterolateral Arthrodesis for Spondylolisthesis

Chapter 64 Posterolateral Arthrodesis for Spondylolisthesis James T. Guille and Reginald S. Fayssoux DEFINITION Spondyl…

274

Chapter 274 31 min

Triple Innominate Osteotomy: Restoring Hip Stability Around the Femoral Head

Chapter 73 Triple Innominate Osteotomy Dennis R. Wenger and Maya E. Pring DEFINITION Triple innominate osteotomy (TIO) …

275

Chapter 275 12 min

Spica Casting of Femur: Expert Guide to Closed Reduction

Chapter 11 Closed Reduction and Spica Casting of Femur Fractures Matthew R. Garner and John M. Flynn DEFINITION Femoral…

276

Chapter 276 18 min

Heal Your Joint: Expert Drilling of Osteochondritis Techniques

Chapter 24 Arthroscopic Drilling of Osteochondritis Dissecans Theodore J. Ganley, Gilbert Chan, and Aaron B. Heath DEFI…

277

Chapter 277 28 min

Mastering fixation of peritrochanteric hip fractures: techniques & outcomes

Chapter 8 Open Reduction and Internal Fixation of Peritrochanteric Hip Fractures Matthew E. Oetgen and Michael R. Baumg…

278

Chapter 278 19 min

Femoral Osteotomy: Realigning the Femur for Hip Health

DEFINITION This chapter focuses on the use of intertrochanteric adduction (varus) osteotomy to reorient the proximal fe…

279

Chapter 279 21 min

Fluted Stems: Your Solution for Femoral Bone Loss in THA

DEFINITION A fluted stem can be used to revise a loose femoral implant with one or more of the following: Cavitary or s…

280

Chapter 280 49 min

Spinal Pelvic Fixation: Open Reduction for Sacroiliac & Sacrum

Chapter 3 Open Reduction and Internal Fixation of the Sacroiliac Joint and Sacrum Henry Claude Sagi DEFINITION Pelvic f…

281

Chapter 281 42 min

Hip Resurfacing: Preserving Vital Bone Around the Femoral Neck

DEFINITION Surface replacement is a significant development in the evolution of hip arthroplasty. Hip resurfacing is ba…

282

Chapter 282 24 min

Mastering Anterolateral Femoral Headneck Impingement: Anterior Approach

DEFINITION Anterior femoroacetabular impingement encompasses a category of structural hip disorders that are characteri…

283

Chapter 283 35 min

Nailing of the Proximal Femur: Avoid Surgical Complications

Cephalomedullary Nailing of the Proximal Femur The proximal femur has a variety of fractures that can occur. While some…

284

Chapter 284 28 min

Proximal Femoral Replacement: A Solution for Total Femur Replacement

DEFINITION Proximal femur replacement is a salvage limb-sparing surgery for nononcologic and ongologic indications that…

285

Chapter 285 33 min

Unlock Success: Calcaneal Fracture Surgery via Extensile Lateral Approach

DEFINITION An intra-articular calcaneus fracture is an injury that involves the joint surfaces of the calcaneus, usuall…

286

Chapter 286 15 min

Mastering Uncemented Total Hip Arthroplasty: A Complete Guide

Chapter 2 Uncemented Total Hip Arthroplasty Matthew S. Austin and Brian A. Klatt DEFINITION Total hip arthroplasty is t…

287

Chapter 287 36 min

Mastering Open Reduction & Internal Fixation of the Posterior Acetabulum

Chapter 4 Open Reduction and Internal Fixation of the Posterior Wall of the Acetabulum Jodi Siegel and David C. Templem…

288

Chapter 288 38 min

Optimizing ORIF for Tibial Plafond Fractures: A Modern Approach

DEFINITION In orthopedic surgery, the terms pilon and plafond have been loosely translated and interchangeably used to …

289

Chapter 289 33 min

Mastering Retrograde Nailing for Distal Femoral Fractures

Chapter 9 Retrograde Intramedullary Nailing of the Femur Laura S. Phieffer and Ronald Lakatos DEFINITION Retrograde fem…

290

Chapter 290 15 min

Deciding to Remove Hip Arthroplasty with Well-Fixed Components

DEFINITION Well-fixed femoral and acetabular implants often have to be removed during revision total hip arthroplasty (…

291

Chapter 291 26 min

FAI: Impingement and Surgical Dislocation Explained

Femoroacetabular Impingement and Surgical Dislocation of the Hip DEFINITION Femoroacetabular impingement (FAI) is a pat…

292

Chapter 292 34 min

Periacetabular Osteotomy: Realigning the Hip Socket via Anterosuperior Iliac Spine

Chapter 13 ‌ Periacetabular Osteotomy Marco Teloken, David Gusmao, and Marcus Crestani DEFINITION According to the pref…

293

Chapter 293 36 min

Hip Arthroplasty & Spacer: Beating Infection, Boosting Recovery

DEFINITION Resection arthroplasty and insertion of a spacer is used for the management of chronic deep periprosthetic i…

294

Chapter 294 47 min

Hemiarthroplasty: Get the b tech fig on Hip Implant Types

Hemiarthroplasty of the Hip Hari P. Bezwada, Robert H. Cho, and David G. Nazarian DEFINITION Femoral neck fractures are…

295

Chapter 295 44 min

Hip Arthroplasty Cemented: A Comprehensive Guide to This Successful Procedure

DEFINITION For the past 40 years, cemented total hip arthroplasty (THA) has been the most successful surgical solution …

296

Chapter 296 42 min

Optimizing Anterograde Intramedullary Nailing for Femur Fractures

Chapter 10 Anterograde Intramedullary Nailing of the Femur Bruce H. Ziran, Natalie L. Talboo, and Navid M. Ziran DEFINI…

297

Chapter 297 13 min

Achieve Lasting Results: Uncemented Tapered Fluted Hip Reimplantation

DEFINITION Hip reimplantation refers to the insertion of another prosthesis after removal of the original, infected pro…

298

Chapter 298 12 min

Restore Hip Bone Loss: Stainless Steel Mesh & Impaction Grafting

DEFINITION Acetabular bone loss remains a challenge to the joint reconstruction surgeon. Bone loss may be the result of…

299

Chapter 299 15 min

Antiprotrusio Cages: Key to Hip Arthroplasty with Acetabular Loss

DEFINITION Acetabular bone deficiency may occur primarily (eg, dysplasia, inflammatory arthritis, seronegative arthropa…

300

Chapter 300 44 min

Complex Distal Femur Fractures: See the patient in figure's solution.

Chapter 11 Open Reduction and Internal Fixation of the Distal Femur Animesh Agarwal DEFINITION Distal femur fractures a…

301

Chapter 301 32 min

Optimizing External Fixation for Lateral Compression Injuries

Chapter 1 ‌ External Fixation of the Pelvis Stephen Kottmeier, John C. P. Floyd, and Nicholas Divaris DEFINITION Pelvic…

302

Chapter 302 16 min

End Chronic Synovitis: Arthroscopic Relief with Portal & Shaver

Chapter 32 Arthroscopic Synovectomy Anne E. Colton, Charles Bush-Joseph, and Jeffrey S. Earhart DEFINITION Synovitis is…

303

Chapter 303 21 min

Unlock Relief: Arthroscopic Treatment of Epicondylitis Explained

Arthroscopic Treatment of Epicondylitis DEFINITION Epicondylitis is overuse tendinosis at the elbow, with pain localize…

304

Chapter 304 21 min

J. W. Thomas on Snapping Hip: Causes, Cures & Relief

Chapter 27 Snapping Hip J. W. Thomas Byrd and MaCalus V. Hogan DEFINITION Coxa saltans is a term popularized by Allen a…

305

Chapter 305 21 min

Resolving Femoral Head Neck Impingement: Arthroscopic FAI Solutions

Chapter 26 Arthroscopic Management of Femoroacetabular Impingement Christopher M. Larson and Rebecca M. Stone DEFINITIO…

306

Chapter 306 35 min

Learn Arthroscopic Meniscectomy: See Chap Sm for Key Insights

Chapter 33 Arthroscopic Meniscectomy Frederick M. Azar DEFINITION Irreparable meniscal tears are those for which no hea…

307

Chapter 307 24 min

Relief from Subacromial Impingement: Arthroscopic Treatment

Chapter 8 Arthroscopic Treatment of Subacromial Impingement R. Timothy Greene and Spero G. Karas DEFINITION Impingement…

308

Chapter 308 35 min

Resolve Long Head Biceps Pain: Advanced Arthroscopic Treatment

Chapter 7 Arthroscopic Treatment of Biceps Tendonopathy J. R. Rudzki and Benjamin S. Shaffer DEFINITION The long head o…

309

Chapter 309 20 min

Minimally Invasive Treatment for Scapulothoracic Disorders

Chapter 16 Arthroscopic Treatment of Scapulothoracic Disorders Michael J. Huang and Peter J. Millett DEFINITION Several…

310

Chapter 310 9 min

Relieve Nerve Entrapment Pain with Arthroscopic Release

Chapter 14 Arthroscopic Release of Nerve Entrapment Felix H. Savoie III and Larry D. Field DEFINITION Suprascapular ner…

311

Chapter 311 15 min

Antiprotrusio Cage Revision: Solving Acetabular Bone Loss

Revision Total Hip Arthroplasty With Acetabular Bone Loss: Antiprotrusio Cage Revision Total Hip Arthroplasty With Acet…

312

Chapter 312 41 min

Femur Anterograde Intramedullary Nailing: A Comprehensive Guide

Anterograde Intramedullary Nailing of the Femur Anterograde Intramedullary Nailing of the Femur DEFINITION A femoral sh…

313

Chapter 313 44 min

Precision Femur Open Reduction for Distal Fracture Repair

Open Reduction and Internal Fixation of the Distal Femur A DEFINITION Distal femur fractures are difficult, complex inj…

314

Chapter 314 11 min

httphutaiforthocomen Applied Surgical Approaches: The Complete Orthopedic Guide

ALL ORTHOPEDIC SURGICAL APPROUCHES Approaches for External Fixation Humerus-Radius,... Approaches for External Fixation…

315

Chapter 315 25 min

Posterior Approach to the Humeral Diaphysis: Anatomy, Techniques & Radial Nerve Protection

Explore the posterior approach to the humeral diaphysis, a fundamental technique for complex fractures and nonunions. U…

316

Chapter 316 35 min

Posterolateral Ankle Approach: Surgical Technique for Posterior Malleolar Fractures & Anatomy

Master the posterolateral ankle approach for posterior malleolar fractures. This guide covers epidemiology, critical su…

317

Chapter 317 21 min

Surgical Lateral Approach to the Knee: Anatomy, Biomechanics & Clinical Considerations

Explore the surgical lateral approach to the knee, covering detailed anatomy, biomechanics, common injuries like LCL & …

318

Chapter 318 9 min

Acetabulum Posterior Approach: Simplest Fix for Hip Fractures

Posterior Approach to the Acetabulum The posterior approach gives access to the posterior wall of the acetabulum and it…

319

Chapter 319 20 min

Precision Anterolateral Approach: Joint & Subacromial Surgery Guide

Anterolateral Approach to the Acromioclavicular Joint and Subacromial Space ‌ The anterolateral approach to the shoulde…

320

Chapter 320 22 min

Mastering the Anterior Approach to the Cubital Fossa: Anatomy, Indications & Technique

Explore the anterior approach to the cubital fossa, a critical pathway for accessing median, radial nerves, brachial ar…

321

Chapter 321 17 min

Ilioinguinal Approach: Master the Deep Inguinal Ring for Success

Ilioinguinal Approach to the Acetabulum The ilioinguinal approach allows exposure of the inner surface of the pelvis fr…

322

Chapter 322 23 min

Sacroiliac Joint Anterior Approach: Comprehensive Review of Anatomy, Biomechanics & Surgical Rationale

Understand the anterior sacroiliac joint approach. This guide details surgical anatomy, biomechanics, and specific indi…

323

Chapter 323 24 min

Medial Approach to the Knee: Comprehensive Anatomy, Biomechanics, and Surgical Foundations

Master the medial approach to the knee. This guide covers detailed surgical anatomy of sMCL, dMCL, POL, and key biomech…

324

Chapter 324 22 min

Optimizing the Posterior Approach with Olecranon Osteotomy for Elbow Trauma & Reconstruction

Explore the posterior approach with olecranon osteotomy for elbow surgery, offering superior visualization for complex …

325

Chapter 325 8 min

Navigating the Anatomy of the Ilioinguinal in Acetabular Surgery

Applied Surgical Anatomy of the Ilioinguinal Approach to the Acetabulum Overview The applied anatomy of this approach i…

326

Chapter 326 24 min

First MTP Joint Dorsal Approaches: Anatomy, Biomechanics & Surgical Principles

Explore the first MTP joint dorsal approach, covering epidemiology, detailed surgical anatomy (bony, ligamentous, tendi…

327

Chapter 327 19 min

Minimally Invasive Anterolateral Approach for Proximal Tibia Fractures: Perfecting Soft Tissue Preservation

Master the minimally invasive anterolateral approach for proximal tibia fractures. Understand critical surgical anatomy…

328

Chapter 328 24 min

Posterior Knee Approach: Comprehensive Surgical Anatomy, Epidemiology, & Neurovascular Safeguards

Explore the posterior knee approach: indications, epidemiology, and detailed surgical anatomy of the popliteal fossa. L…

329

Chapter 329 21 min

Midlateral Approach: Precision for Flexor Sheaths Proximal

Midlateral Approach to the Flexor Sheaths, Proximal and Middle Phalanges The midlateral approach is a popular way of re…

330

Chapter 330 9 min

Simple & Safe Posterior Approach to the Sacroiliac: Key Techniques

Posterior Approach to the Sacroiliac Joint The posterior approach to the sacroiliac joint is a simple, safe approach th…

331

Chapter 331 24 min

Mastering the Anterolateral Approach to the Elbow: Anatomy & Surgical Applications

Explore the anterolateral approach to the elbow, a key surgical exposure for complex fractures, nerve entrapments, and …

332

Chapter 332 25 min

Medial Parapatellar Approach: Comprehensive Surgical Anatomy & Clinical Applications

Explore the medial parapatellar approach, the foundational knee access for arthroplasty, trauma & sports. Learn epidemi…

333

Chapter 333 23 min

The Dorsolateral Approach for Hallux Valgus: Anatomy, Biomechanics, and Surgical Principles

Master the dorsolateral approach for hallux valgus correction. Understand its epidemiology, surgical anatomy, biomechan…

334

Chapter 334 25 min

Surgical Anatomy of the Ulna: Approaches, Biomechanics, and Complication Prevention

Master the surgical anatomy of the ulna. This guide details osteology, ligaments, and muscles crucial for effective ort…

335

Chapter 335 21 min

Dorsolateral Approach to Scaphoid Fractures: A Comprehensive Surgical Guide

Explore the dorsolateral approach to scaphoid fractures. This guide details surgical anatomy, critical neurovascular st…

336

Chapter 336 16 min

Dorsal Approach for Morton's Neuroma Excision: A Comprehensive Guide

Explore the dorsal surgical approach for Morton's neuroma, a superior technique for forefoot pain relief. Understand it…

337

Chapter 337 23 min

The Dorsal Approach to the Wrist: Anatomy, Epidemiology & Surgical Principles

Delve into the dorsal wrist approach. Learn its epidemiology for fractures & ganglions, detailed surgical anatomy inclu…

338

Chapter 338 21 min

Mastering the Minimally Invasive Anterior Humeral Shaft Approach

Minimally Invasive Anterior Approach to the Humeral Shaft ‌ The minimally invasive anterior approach to the humerus uti…

339

Chapter 339 24 min

Mastering Distal Femur for Anterior ACL: Lateral Approach

Lateral Approach to the Distal Femur for Anterior Cruciate Ligament Surgery ‌ The lateral approach to the distal femur,…

340

Chapter 340 23 min

Comprehensive Guide to the Anterior Ankle Approach: Anatomy, Biomechanics & Indications

Explore the anterior approach to the ankle: epidemiology, detailed surgical anatomy (nerves, vessels, tendons), biomech…

341

Chapter 341 21 min

Ankle Posteromedial Approach: Comprehensive Surgical Anatomy, Indications, & Technique

Master the posteromedial ankle approach. Explore critical surgical anatomy, including tendons, nerves, and vessels. Und…

342

Chapter 342 26 min

Comprehensive Surgical Anatomy of the Bony Pelvis & Pelvic Ring Injuries

Comprehensive surgical anatomy of the bony pelvis and pelvic ring. Covers epidemiology, bony architecture, critical lig…

343

Chapter 343 24 min

External Fixation Pelvis-Femur-Tibia: Expert Approaches

The Pelvis External fixation of the pelvis is used in life-threatening situations to achieve hemodynamic stability. The…

344

Chapter 344 26 min

The Posterolateral Approach to the Tibia: Indications, Surgical Anatomy, and Technique Overview

Explore the posterolateral approach to the tibia for complex fractures & compromised soft tissues. Understand its criti…

345

Chapter 345 20 min

Precision Volar Approach to Carpal Tunnel & Wrist: Comprehensive Surgical Guide

Explore the precision volar approach to carpal tunnel and wrist surgery. This guide details intricate surgical anatomy,…

346

Chapter 346 22 min

Proximal Tibial Posteromedial Approach: Comprehensive Guide to Anatomy, Biomechanics, and Complex Fracture Fixation

Explore the proximal tibial posteromedial approach for complex fractures. Learn its biomechanical rationale, surgical a…

347

Chapter 347 16 min

Proximal Humerus Lateral Approach: Comprehensive Guide to Anatomy & Surgical Technique

Discover the proximal humerus lateral approach. Learn surgical anatomy (axillary nerve), biomechanics, fracture indicat…

348

Chapter 348 24 min

Demystifying the Posterolateral Approach to the Femur

Posterolateral Approach to the Femur‌ ‌ The posterolateral approach 1 – 3 can expose the entire length of the femur. Be…

349

Chapter 349 12 min

Anterior Hip Mastery: Navigating Latae & Sartorius for Optimal Access

Anterior Approach to the Hip Operations on the hip joint are among the most common surgical procedures performed in ort…

350

Chapter 350 23 min

Optimizing the Femur Lateral Approach: Comprehensive Guide to Technique, Anatomy, and Indications

Master the femur lateral approach. This guide covers surgical anatomy, vastus lateralis splitting, biomechanics, and in…

351

Chapter 351 14 min

Comprehensive Guide to the Direct Lateral Approach (DLA) for Hip Arthroplasty

The Direct Lateral Approach (DLA) offers a comprehensive pathway for hip surgery. Learn its technique, crucial surgical…

352

Chapter 352 20 min

Minimally Invasive Plate Osteosynthesis (MIPO) for Distal Femoral Fractures: An Academic Review

Explore Minimally Invasive Plate Osteosynthesis (MIPO) for distal femoral fractures. Understand surgical anatomy, biome…

353

Chapter 353 24 min

Achieve Faster Recovery: Hip Minimally Invasive Anterior Approach

Minimally Invasive Anterior Approach to the Hip The minimally invasive anterior approach to the hip is used mainly for …

354

Chapter 354 21 min

Minimally Invasive Surgery for Precise Retrograde Femoral Nailing

Minimally Invasive Surgery for Retrograde Intramedullary Nailing of the Femur‌ The minimally invasive approach for retr…

355

Chapter 355 12 min

Demystify Posterior Approaches to the Hip: Essential Anatomy

Applied Surgical Anatomy of the Posterior Approaches to the Hip and the Acetabulum Overview The muscles covering the po…

356

Chapter 356 12 min

Master the Hip Anterolateral Approach: Techniques & Key Uses

Anterolateral Approach to the Hip The anterolateral approach is the approach most commonly used for total joint replace…

357

Chapter 357 20 min

Complex Management of Chronic Infected Femoral Mid-Diaphyseal Nonunion: A Case Study

Explore a complex case of a 48-year-old male with chronic infected femoral mid-diaphyseal nonunion following trauma. De…

358

Chapter 358 23 min

Medial Hip Approach & Obturator Division: Anatomy, Indications, and Surgical Technique

Explore the medial hip approach (Ludloff) for CDH, tumors, and spasticity. Master surgical anatomy, including obturator…

359

Chapter 359 7 min

Surgical Hip Approaches: Master the Tensor Fasciae Latae Anatomy

Applied Surgical Anatomy of the Anterior, Lateral, and Anterolateral Approaches to the Hip Overview The fascia lata cov…

360

Chapter 360 22 min

Optimizing the Anteromedial Approach for Distal Femur: Anatomy, Biomechanics, & Applications

Explore the anteromedial approach to the distal femur, its epidemiology, and crucial surgical anatomy. Understand biome…

361

Chapter 361 9 min

Minimally Invasive Approach for Femur Intramedullary Nailing Success

Minimally Invasive Approach to the Proximal Femur for Intramedullary Nailing‌ The minimally invasive approach to the pr…

362

Chapter 362 8 min

Posterior Hip Approach: Optimize the Aspect of the Trochanter

Posterior Approach to the Hip The posterior approach is the most common and practical of those used to expose the hip j…

363

Chapter 363 25 min

Advanced Surgical Management of Pelvic & Acetabular Fractures: Anatomy & Approaches

Master advanced management of pelvic and acetabular fractures. Understand epidemiology, key classifications, intricate …

364

Chapter 364 27 min

Mastering Femoral Surgical Approaches: Anatomy, Biomechanics, & Neurovascular Safety

Explore comprehensive femoral surgical approaches, focusing on detailed anatomy, biomechanics, neurovascular structures…

365

Chapter 365 84 min

Unlocking Every Aspect of the Hip's Surgical Approaches

Approaches to the Hip click the link below Anterior Approach to the Hip Minimally Invasive Anterior Approach to the Hip…

366

Chapter 366 35 min

Developmental Dysplasia of the Hip (DDH): History, Epidemiology & Surgical Anatomy

Explore the comprehensive history, epidemiology, and surgical anatomy of Developmental Dysplasia of the Hip (DDH). Unde…

367

Chapter 367 29 min

Mastering Hip DysplasiaImaging & Other Diagnostic Methods

Developmental Dislocation (Dysplasia) of the Hip (DDH)-IMAGING AND OTHER DIAGNOSTIC STUDIES ■ Dynamic hip ultrasound ca…

368

Chapter 368 27 min

Developmental Dysplasia of the Hip (DDH): Etiology, Risk Factors & Surgical Anatomy

Understand Developmental Dysplasia of the Hip (DDH) – its spectrum, multifactorial causes, and critical risk factors li…

369

Chapter 369 26 min

Hip Dysplasia Treatment: Outcomes, Recovery, & Preventing Complications

Developmental Dislocation (Dysplasia) of the Hip (DDH)-Treatment-Outcomes-Recovery-Complications ■When DDH is detected …

370

Chapter 370 31 min

Developmental Dysplasia of the Hip (DDH): Natural History, Epidemiology & Surgical Anatomy

Explore Developmental Dysplasia of the Hip (DDH), its progressive natural history, epidemiology (incidence, risk factor…

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Prof. Dr. Mohammed Hutaif

Consultant Orthopedic & Spine Surgeon

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