Posterior approach to the hip joint(41)
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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]
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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).
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K.Mohan Iyer
Approaches to the Hip Joint
1.Anterior 2.Anterolateral 3.Lateral 4.Medial 5.Anteromedial 6.Posterolateral 7.Posterior
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K.Mohan Iyer
Posterolateral Approaches to the Hip Joint
1.Gibson(1950) 2.Marcy & Fletcher(1954)
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K.Mohan Iyer
Anterior Approaches to the Hip Joint
1.Smith Peterson(1919) 2.Somerville(1953)
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K.Mohan Iyer
Anterolateral Approaches to the Hip Joint
1.Smith Peterson,Cave & Van Gorder(1949)2.Desmond Dall(1986)3.Stephenson & Freeman(1991)
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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)
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K.Mohan Iyer
Lateral Approaches to the Hip Joint(Contd.)
8.Learmonth & Allen(1996)9.Mulliken et al(1998)
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K.Mohan Iyer
Medial Approaches to the Hip Joint
1.Ludloff(1908)
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K.Mohan Iyer
Anteromedial Approaches to the Hip Joint
1.Zazepen & Gamidov(1972)
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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)
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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
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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.
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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.
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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.
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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.
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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.
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K.Mohan Iyer
Cadaveric Study
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K.Mohan Iyer
Cadaveric Study
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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.
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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.
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K.Mohan Iyer
Cadaveric Study
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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.
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K.Mohan Iyer
POSTERIOR APPROACH TO THE HIP JOINT
K.MOHAN IYER
CADAVERIC DISPLAY
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K.Mohan Iyer
Skin Incision
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K.Mohan Iyer
Gluteal Fascia
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K.Mohan Iyer
Gluteus Maximus
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K.Mohan Iyer
Short External Rotaters
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K.Mohan Iyer
Trochanteric Osteotomy
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K.Mohan Iyer
Hip Joint Opened
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K.Mohan Iyer
Hip Joint Dislocated
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K.Mohan Iyer
Head and Neck resected
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K.Mohan Iyer
Total Hip Prosthesis inserted
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K.Mohan Iyer
Wiring of TrochantericFragment
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K.Mohan Iyer
Hip Joint Reconstituted
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K.Mohan Iyer
Radiograph of Total Hip Prosthesis
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K.Mohan Iyer
Radiograph of Bipolar Prosthesis
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K.Mohan Iyer
Radiograph of Thompson’sHemi-Arthroplasty
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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.
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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.
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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.