Posterior approach to the hip joint(41)

POSTERIOR APPROACH TO THE HIP JOINT

Dr K Mohan Iyer

This is my original research done on cadavers in 1981.

This is the power point presentation of mine at:1. The Posterior Approach to the Hip Joint – K. Mohan Iyer, Association of Surgeons of India

Conference, Mumbai - December 1982.2. Asean Orthopaedic Association Congress, Singapore – October 1984.

This Approach of mine was described in detail in The Year Book of Orthopaedics 1982-MarkB.Coventry,371-373.It has also been described in the following books of International repute:1. Campbell’s Operative Orthopaedics (1992), Ninth Edition,Volume-1, S. Terry Canale, Pages

140,387,466.2. The Adult Hip (Lippincott-Raven) (1998), Volume 1, Callaghan, Rosenberg and Rubash,

Pages:700-701,718.3. Surgery of the Hip,Elsevier, Mosby/Saunders,Volume 2, by Daniel J.Berry and Jay

R.Lieberman, Page No.269.4. Campbell’s Textbook of Operative Orthopaedics,12th Edition,by S.Terry Canale and James

H.Beaty,Page No.331

I am also preparing my own website narrating all the original research work done by me for the last 30 years till to date(1/1/2014) -> http://www.kmohaniyer.com My email address is: [email protected]

K.Mohan Iyer

POSTERIOR APPROACH TO THE HIP JOINT

K.MOHAN IYER

M.Ch.Orth(Liverpool, U.K.),M.S.Orth(BOM)F.C.P.S.Orth(BOM),D’Orth(BOM),M.B.,B.S.(BOM).

K.Mohan Iyer

Approaches to the Hip Joint

1.Anterior 2.Anterolateral 3.Lateral 4.Medial 5.Anteromedial 6.Posterolateral 7.Posterior

K.Mohan Iyer

Posterolateral Approaches to the Hip Joint

1.Gibson(1950) 2.Marcy & Fletcher(1954)

K.Mohan Iyer

Anterior Approaches to the Hip Joint

1.Smith Peterson(1919) 2.Somerville(1953)

K.Mohan Iyer

Anterolateral Approaches to the Hip Joint

1.Smith Peterson,Cave & Van Gorder(1949)2.Desmond Dall(1986)3.Stephenson & Freeman(1991)

K.Mohan Iyer

Lateral Approaches to the Hip Joint

1.Watson Jones(1935) 2.Harris(1967) 3.McFarland & Osborne(1954) 4.Hardinge(1982) 5.McLauchlan(Stracathro Approach-1984) 6.Itokazu M,Ohno & Itoh Y(1988) 7.Frndak P.A,Mallory T.H.&Lombardi A.V(1992)

K.Mohan Iyer

Lateral Approaches to the Hip Joint(Contd.)

8.Learmonth & Allen(1996)9.Mulliken et al(1998)

K.Mohan Iyer

Medial Approaches to the Hip Joint

1.Ludloff(1908)

K.Mohan Iyer

Anteromedial Approaches to the Hip Joint

1.Zazepen & Gamidov(1972)

K.Mohan Iyer

Posterior Approaches to the Hip Joint

1. Osborne(1931) 2. Moore(1959) 3. Iyer(1981) 4. Wayne J.Daum(1985) 5. Hedley et al(1990) 6. James A.Shaw(1991)

K.Mohan Iyer

Posterior Approach to the Hip Joint – K.Mohan Iyer

1.A New Posterior Approach to the Hip Joint –K.Mohan Iyer,Injury,13,76-80,1981.

2.Experience with Thompson’s prosthesis using the New Posterior Approach – K.Mohan Iyer,M.A.Shatwell & M.A.Elloy,Injury,14,243-244,1982.

3.The Year Book of Orthopaedics 1982 – Mark B.Coventry,371-373

K.Mohan Iyer

Posterior Approach to the Hip joint-K.Mohan Iyer

4.A Posterior Approach to the Hip Joint withcomplete posterior capsular and muscularrepair;A.K.Hedley,D.H.Hendren & L.P.Mead(1990) Journal of Arthroplasty:Vol.5;Supplement October 1990:S 57 to S 66.

K.Mohan Iyer

Posterior Approach to the Hip Joint – K.Mohan Iyer

5.Clinical Experience with the Iyer modification of the Posterior Approach to the Hip – F.H.Beddow & C.Tulloch,J.Bone Joint Surg,1991,73B,Supp II:164-165.

6.Experience with a Modified PosteriorApproach to the Hip Joint.A technical

note;Shaw J.A:Journal of Artrhroplasty: (1991) Vol.6;No.1:11-18.

K.Mohan Iyer

Posterior Approach to the Hip Joint-K.Mohan Iyer

7.Campbell’s Operative Orthopaedics(1992),Ninth Edition,Volume One,S.Terry Canale,Pages:140,387 & 466.

8.The Adult Hip(Lippincott-Raven)(1998),Volume 1,Callaghan,Rosenberg & Rubash,Pages 700-701,718.

K.Mohan Iyer

Posterior Approach to the Hip Joint-K.Mohan Iyer

9.Failure of Reinserted Short External Rotator Muscles after Total Hip Arthro- plasty;Thomas Stahelin,P.Vienne & O.Hershe(2002),Journal of Arthroplasty, Vol.17,No.5;604-607.

K.Mohan Iyer

CADAVERIC STUDY

AIM:To compare the stability of the Hip Joint using this approach,with the Southern Approach. Apparatus used measures the angles of flexion/extension,adduction/abduction Int.Rotaion/Ext.Rotation of the Hip Joint, with the pelvis fixed.

K.Mohan Iyer

Cadaveric Study

K.Mohan Iyer

Cadaveric Study

K.Mohan Iyer

CADAVERIC STUDY

Comparison’s made in a single cadaver with 1.Both Hips exposed by different approaches,with hemi-arthroplasty done. 2.Both Hips exposed by different approaches,without any arthroplasty done.

K.Mohan Iyer

CADAVERIC STUDY

Standard Dislocation Manoeuvre – Torque applied in Internal Rotaion,with the Hip Joint held in a fixed angle of flexion and adduction. Torque required to disrupt trochanteric fixation was more as compared to the Southern Approach.

K.Mohan Iyer

Cadaveric Study

K.Mohan Iyer

CADAVERIC STUDY

CONCLUSION: The Torque required to disrupt the Trochanteric fixation in this Approach is around 68 Nm,as compared to the conventional Southern Approach where the repair of the short lateral rotators,disrupts around 30 Nm to 50 Nm. with disruption & dislocation. *Hence Greater Stability,by this New Approach.

K.Mohan Iyer

POSTERIOR APPROACH TO THE HIP JOINT

K.MOHAN IYER

CADAVERIC DISPLAY

K.Mohan Iyer

Skin Incision

K.Mohan Iyer

Gluteal Fascia

K.Mohan Iyer

Gluteus Maximus

K.Mohan Iyer

Short External Rotaters

K.Mohan Iyer

Trochanteric Osteotomy

K.Mohan Iyer

Hip Joint Opened

K.Mohan Iyer

Hip Joint Dislocated

K.Mohan Iyer

Head and Neck resected

K.Mohan Iyer

Total Hip Prosthesis inserted

K.Mohan Iyer

Wiring of TrochantericFragment

K.Mohan Iyer

Hip Joint Reconstituted

K.Mohan Iyer

Radiograph of Total Hip Prosthesis

K.Mohan Iyer

Radiograph of Bipolar Prosthesis

K.Mohan Iyer

Radiograph of Thompson’sHemi-Arthroplasty

K.Mohan Iyer

DISCUSSION

ADVANTAGES: 1.Bloodless field. 2.Wider visualisation of the acetabulum. 3.Markedly increased stability. 4.Very useful in senile/demented patients.

K.Mohan Iyer

DISCUSSION

DISADVANTAGES: 1.Trochanteric Osteotomy,wherein bony

union takes twice the time required for soft tissues to heal.

2.Problems related to wires.

K.Mohan Iyer

Concerns Expressed about this Posterior Approach

1.Metal Failure with breakage. 2.Heterotrophic Ossification. 3.Non-Union of trochanteric fragment. 4.Fibrous Union of trochanteric fragment. 5.Greater Trochanteric Bursitis.