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Acetabular orientation: anterolateral approach in the supine position.

ABSTRACT: The anterolateral approach in the supine position provides excellent visualization of the acetabulum. The main advantage of the approach, a low dislocation rate, has been demonstrated in the literature, while the purported disadvantage of abductor dysfunction has not been clearly delineated in the literature. The technique requires meticulous attention to preservation of the gluteus medius and minimus tendons. Impingement and dislocation are avoided by careful attention to the preparation of acetabulum, critical assessment of the implanted components, and intraoperative trialing. Leg lengths are assessed through direct palpation of the malleoli. Routine use of postoperative hip precautions is not necessary when this approach is utilized. The anterolateral approach in the supine position allows for a reproducible result with a low dislocation rate.Level V, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

SUBMITTER: Austin MS

PROVIDER: S-EPMC2600976 | biostudies-other | 2009 Jan

REPOSITORIES: biostudies-other

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Project description:Total hip arthroplasty through minimally invasive procedures potentially reduces operative trauma, which is expected to result in improved recovery and rehabilitation. We presently perform total hip arthroplasty using minimally invasive techniques via an anterolateral modification of the Watson-Jones approach. This approach is performed in the supine position and requires sterile draping of both legs. It also involves a modified operative technique which preserves the pelvitrochanteric muscles and extends the release of the hip capsule. In order to employ a proven implant system (BICON-PLUS threaded cup, SL-PLUS stem), it was necessary to modify the stem rasps and use manipulation rasps as trial stems. In this report, we compare 50 conventional total hip replacements with 50 procedures performed using the minimally invasive procedure in terms of blood loss and the duration of the operation. The length of the skin incision varied between 7 and 12 cm with the minimally invasive technique, compared to 15 to 22 cm with the conventional procedure. Both groups were virtually identical with respect to average blood loss (haemoglobin on 10th post-operative day: minimally invasive group, 108.0 g/L; conventional group, 112.0 g/L) and the duration of the procedure (minimally invasive group, 60 minutes; conventional group, 58 minutes). The position of the implanted components correlated with the pre-operative planning with regard to medial head offset, centre of rotation of the hip, and leg length, and was as satisfactory as that observed with the conventional procedure. The complication rate was low (2.9%). Shaft fissures occurred in the first months of use of the minimally invasive procedure before adaptation of the shaft rasps. Dislocations were attributable to improper patient behaviour. Minimally invasive surgery via the anterolateral approach in the supine position was equivalent to the conventional procedure, had a low rate of complications, and did not adversely impact the technical success of the procedure.

Project description:IntroductionUltrasound guidance for percutaneous nephrolithotomy (PCNL) has gained acceptance amongst urologists given its numerous advantages over fluoroscopy. While traditionally performed in the prone position, this video demonstrates a step-by-step approach to performing PCNL in the supine position, solely under ultrasound guidance.Materials and methodsOnce in the modified supine (Galdakao-modified Valdivia) position, important anatomic landmarks are identified. It is important to first orient the ultrasound probe such that its cranial side corresponds to the left of the ultrasound screen. After optimizing a target calyx, keeping the needle in the imaging plane of the probe facilitates renal access. Tract dilation under ultrasound guidance is then achieved by keeping the wire and dilators in the same imaging plane.ResultsThe 11th and 12th ribs, paraspinous muscle, iliac crest, midaxillary line, and costal margin are the anatomic landmarks that orient the probe to the location of the kidney. Placing the ultrasound probe in the midaxillary line, parallel to the 11th rib allows the operator to identify key renal landmarks: the renal cortex, peri-pelvic fat, collecting system, kidney stone with its associated postacoustic shadow, and the intended target calyx. Controlling the needle is easiest in the longitudinal view, as the needle can be visualized from skin to target. Dilation under ultrasound relies on keeping the wire in view. The tip of the 10-French dilator is based on the location where the wire image disappears as the dilator advances. The balloon dilator tip is visualized on ultrasound reaching the appropriate depth just inside the collecting system, at which time balloon inflation results in complete dilation of the tract.ConclusionsThis video provides a step-by-step approach demonstrating that PCNL can be performed in the supine position using only ultrasound-guidance. This approach facilitates renal access in this position and obviates the need for radiation exposure.

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Acetabular orientation: anterolateral approach in the supine position.

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