); The Foundation for the Advancement in Research in Medicine, Inc. A 501(c)(3) non-profit organization. - consider the Hardinge approach for any patient who will have difficulty with complying with the usual hip precautions following surgery; ;tL+~>N"z!1/Cmc4gXR21MTK2y See My Other Total Hip Replacement Articles: How To Choose A Surgeon For Hip ReplacementSpeed Up Recovery After Total Hip ReplacementCan I Sit In A Recliner After Hip ReplacementCrossing Legs After Total Hip Surgery: (A PTs Complete Guide)Stairs After Total Hip Replacement: A Physical Therapy GuideIce After Total Knee Replacement: A PTs Complete Guide. The Femoral nerve is the most lateral structure in neurovascular bundle of anterior thigh. Perhaps you are approaching or already retire and wondering how you could earn extra money in retirement.One option would be to do as I am doing.Read my article How To Generate Retirement Income: Cash In On Your Knowledge. You are in: Home Approach Hip Approaches Hardinge Approach. % Expose the interval between the gluteus medius and the tensor fascia lata and extend it proximally over the hip joint. Proper Reaming and Cup Positioning in Primary Total Hip Replacement This is a unique and innovative method of carrying out the replacement and unlike other MIS approaches, allows full vision for the surgeon throughout the procedure. This . March 10, 2021 Asan Medical Center, Seoul, Korea. It provides information to make you a better-informed consumer. Many believe that keeping these muscles intact helps prevent post-surgical dislocations. The direct lateral approach to the hip for arthroplasty. endobj Make a T-shaped capsulotomy to expose the joint, but preserve the acetabular labrum unless a total hip arthroplasty is planned. A layered closure is preferred for periprosthetic fractures. General guidelines (0-6 weeks) adhere to precautions Normalize gait pattern with appropriate aids based on WB'ing status ( time frame for using aids based on the discretion of therapist )on the discretion of therapist ) Hip ROM within restrictions Basic quadricep strength Total Hip Arthroplasty Recent studies have found that hip precautions impact patients recovery both physically and psychologically. Hip precautions refer to certain things that one should not do after having total hip replacement (THR) surgery .Hip precautions are a common component of standard postoperative care following a THR. Approach. Transcending Aging Independently But there is also more than one way to go about performing a hip replacement surgery known as different approaches.. Jacqueline Donaldson, OT, PTA. and place two retraction sutures, anteriorly and posteriorly. split fascia lata and retract anteriorly to expose tendon of gluteus medius. Patient positioning in case of anterolateral approach to the right hip -patient is on his left hand side, surgeon stands behind and looks down on the patients right hip which has been prepared. Towson, MD 21204 The same range-of-motion restrictions from the Posterior Surgical Approach (outlined above) apply to the Lateral Surgical Approach PLUS the restriction of no ACTIVE hip abduction (bringing the leg out to the side). No internal rotation with the Posterior Approach: The most common way that rule is broken is by pivoting on the operated leg when turning in that direction. This approach allows the surgeon to work between the muscles without detaching them from the femur. DTIT]Hiv_~Zd #Ke0z3U?7-3KG|~LH22R9U I2JcAvaePNmgVhDcOb't^OaLK3mTj .!JR5\bdTg?`S>8y^|\Qm/Tt(Qm &+)YRJMj'9pGL4YakEXx Z}]2 5lFJA 1I*k@v35l`zg>}aUP=jv9-vfqXR4!KNax(vqz_ 8r Sc?^bUv=hrPe]F? Hip precautions refer to certain things that one should not do after having total hip replacement (THR) surgery .Hip precautions are a common component of standard postoperative care following a THR.[1]  The precautions are prescribed for 6-12 weeks postoperatively to encourage healing and prevent hip dislocation. The advantages of this approach include a significantly lower dislocation rate compared with other approaches while allowing for excellent acetabular visualization. The first 6 weeks are critical to maintaining these range of motion restrictions and these restrictions will remain precautionary for the rest of life. In addition, it can be adapted for small incision surgery. A mid-lateral skin incision centered over the greater trochanter is made [Figure 3]. The trochanteric approach to the hip for prosthetic replacement. This depends on what approach was utilized to do the hip replacement . Traditionally, protocols describing these restrictions and precautions require patients to sleep supine (usually with an abduction pillow in place), to use walking aids for several weeks, only to sit on high chairs and not to sit cross-legged, not to bend forward or to flex their hip joint beyond 90. The vastus lateralis and the gluteus medius are now exposed. Exposure of the hip by anterior osteotomy of the greater trochanter. Precautions include: o Posterior Precautions: o No hip flexion >90 degrees o No hip internal rotation or adduction beyond neutral J')(o@ct9\ Extend the incision distally along the anterolateral femoral shaft and then release the intervening tissue from the anterior intertrochanteric region, sharply releasing the hip capsule from the anterior femur. The anterior hip replacement procedure has fewer precautions. Abductor . 1. The hip is dislocated through this posterior incision in the joint capsule by the surgeon taking the patients leg into flexion, internal rotation (pigeon-toe), and adduction (across mid-line of the body) to expose the femoral head and acetabular (hip) socket for preparation to receive the replacement components. A common way the No Crossing Mid-line rule is broken is by sleeping on the unoperated side and allowing the operated leg to drop down to the bed crossing the mid-line. - note that if a Steinman pin as been used to retract the medius, it should be removed at this point, since it may placed signficant tension on the medius and give a false sense of hip stability; - Cautions: The anterolateral approach to the hip, described in 1936 by Sir Watson Jones, still is in current use when implanting THA. Advance to treadmill D. Recommended long-term activities after Total Hip Replacement (DeAndrade, KJ - Activities after replacement of the hip or knee, Orthopedic Special Edition 2(6):8, 1993) begin 5cm proximal to tip of greater trochanter. We need to do so in a way that let us repair it in the end. The abductor muscle "split". We also participate in other affiliate programs which compensate us for referring traffic. The trochanteric approach to the hip for prosthetic replacement. Organize in-house training events for your surgical staff, Hand Distal phalanges revision published. [2] Hip precautions mainly apply to the posterior or posterior lateral hip replacement procedure. Hardinge Approach to Hip Joint (Direct Lateral Approach) is used for: There is no true internervous plane for Hardinge approach to hip joint (direct lateral approach). Accessed April 7, 2019. This is the same motion the surgeon used to dislocate the hip through the anterior portion of the joint capsule. mini-incision approach shows no longterm benefits to hip function extend to 10 cm below tip of greater trochanter Superficial dissection through subcutaneous fat incise fascia lata in lower half of incision extend proximally along anterior border of gluteus maximus split gluteus maximus muscle along avascular plane Modified Hardinge Approach for Total Hip Arthroplasty. Hamstring Curl Machine (hip precautions) 9. The structures at risk duringhardinge approach to hip joint (direct lateral approach)include: Orthofixar does not endorse any treatments, procedures, products, or physicians referenced herein. I have yet to see a hip dislocation that has undergone an anterior approach to total hip replacement. The provocative position for hip dislocation is: hip flexion, adduction, internal rotation. Complementary and Alternative Medicine (CAM) for Postop Pain, prosthetic components of an artificial hip, minimally invasive surgery in hip replacement, Minimally invasive hip replacement approaches and procedures, Hip Resurfacing vs. The hip joint is then dislocated and the acetabular socket and femur are exposed for preparation and insertion of the prosthesis components. No hip extension. - Discussion: Close also the gluteus medius tendon and fascia proximally, and the vastus lateralis fascia distally. It exposes the femur well with good access to the joint. . This capsule will need to have time to heal before it can withstand the pressure from the femoral head as it rotates forward when the patient moves into the range-of-motion of external rotation and extension. Adjust the retractors as necessary and debride periarticular fat to expose the hip capsule. Choosing the optimal surgical approach can minimize these risks and therefore improve the outcome of THA. This mistake can be avoided by placing a body pillow between the legs when lying on the unoperated side, but the operated leg MUST be supported from the groin to past the ankle. Recovery and Rehabilitation: Western Health; 2013. It is just a natural instinct to bend forward and lean on the thighs when sitting on the commode. elevate part of the psoas tendon from the capsule. Gluteus medius is a fan shaped muscle and the fibres join distally to form a tendon that inserts into the greater trochanter. The abductor muscle "split". Retract the cut edges of the fascia to pull the tensor fasciae latae anteriorly and the gluteus maximus posteriorly. Translateral surgical approach to the hip. A simple pillow will not work as it allows portions of the leg to be unsupported which develops a fulcrum point that translates into the operated hip. A research paper published in the US National Library Of Medicine: Are Hip Precautions Necessary Post Total Hip Arthroplasty? backs up my observation that Anterior Surgical Approach total hips restrictions having little or no effect on dislocations. Data Trace Publishing Company 3 0 obj - consider the Hardinge approach for patients w/ significant contracture; Risk of dislocation & hip precautions: Risk is incredibly low (<1%). [1] The precautions are prescribed for 6-12 weeks postoperatively to encourage healing and prevent hip dislocation. Never cross legs or ankle on sitting, standing or lying down, Avoid bending your leg greater than 90 degrees. - significant hip flexion contracture: Please consult a licensed physician and/or physical therapist in your area for specific medical advice about your condition. Age In Place School is a division of Buena Physical Therapy Services, Inc.654 Creekmont CtVentura, CA 93003, link to Ice After Total Hip Replacement: A PTs Complete Guide, link to Lower Blood Pressure With A Simple Amino Acid: L-Arginine. The abductor muscle "split". These same range-of-motions that are used to dislocate the hip at the surgery are the same range-of-motion movements that are restricted. Lateral traction and repositioning of the leg can improve visualization. Raised toilet seats or a 3-in-1 commode chair may be required for the patient to be compliant with flexion restrictions. The direct lateral approach to the proximal femur releases the anterior third of the gluteus medius and minimus while preserving the posterior femoral attachment of the major part of these muscles. Capsule. The hip is dislocated through this posterior incision in the joint capsule by the surgeon taking the patient's leg into flexion, internal rotation (pigeon-toe), and adduction (across mid-line of the body) to expose the femoral head and acetabular (hip) socket . - prior to applying the femoral head, consider applying a trial head to be sure that stability is optimal; Incision. The main landmark for the incision is the greater trochanter which overlies the hip joint itself. Stationary bicycle (seat high to maintain hip precautions) 11. How To Choose A Surgeon For Hip Replacement, Speed Up Recovery After Total Hip Replacement, Can I Sit In A Recliner After Hip Replacement, Crossing Legs After Total Hip Surgery: (A PTs Complete Guide), Stairs After Total Hip Replacement: A Physical Therapy Guide, Ice After Total Knee Replacement: A PTs Complete Guide. Begin the incision 5 cm above the tip of the greater trochanter. We are then going to cut straight across the tendon where it inserts into the greater trochanter but leave enough cuff on both sides so as to repair it later. Robotic Assisted Total Hip Replacement. Lateral Approach Total Hip Replacement Precautions: The lateral approach to hip replacement, like the posterior approach, cuts the joint capsule in the posterior of the hip and the surgeon dislocates the femoral head through that incision to expose the femoral head and acetabular socket for preparation to receive the replacement components. The superior approach is relatively new. 2 0 obj FInally did it- March of 2023now another question for all of you, Abductor wedge pillow - sleep tips request. Replacement is designed to precisely reconstruct the hip without stretching or traumatizing muscles that are important to hip function. Direct lateral approach also called as the trans-gluteal approach initially described by Kocher in 1903 popularised by Hardinge in the modern age gives good exposure to the hip joint preserving most of gluteus medius minimus and vastus lateralis, and the vascularity. Divide the gluteus medius into two imaginary thirds. This approach has fewer restrictions. Now feel the greater trochanter and place the incision. Exposure of the hip by anterior osteotomy of the greater trochanter. After 6 weeks the capsule is usually well-healed but 12 weeks is usually considered the time frame for the hip capsule to fully heal. Posterior Approach Total Hip Replacement Precautions: No hip flexion greater than 90 degrees, no crossing the legs, and no internal rotation of the leg: In the Posterior Approach to Total Hip Replacement, the patient is placed side-lying and the operated hip capsule is cut posteriorly. It is later re-attached. In: Frontera WR, Silver JK, Rizzo TD, eds. - if the surgeon attempts to correct the contracture by performing an aggressive anterior capsulotomy, then there is an increased risk of dislocating out the front; - PreOp: For example raised toilet seats and chairs to prevent bending at the hip more than 90 degrees, sock aids and dressing sticks for dressing and changing clothing easier, "easy reachers" to help them get items from the ground. The joint capsule seals the hip joint, much like a zip-lock baggie, to keep the lubricating fluids inside the capsule and bathing the hip joint in this fluid. Dislocation after total hip arthroplasty using the anterolateral abductor split approach. A subfascial drain should be considered as blood loss can be significant and periprosthetic fracture patients are at high risk of requiring anticoagulation immediately postoperatively. Comparison of heterotopic bone after anterolateral, transtrochanteric, and posterior approaches for total hip . Perform a meticulous debridement of all soft tissues before starting wound closure. Exposure of the proximal femur is gained by gentle external rotation of the leg. - in direct lateral approach, a curvilear split is made thru the anterior portion of the gluteus medius and vatus muscles, in order to gain access to the anterior face of the hip joint; The wound is closed in layered fashion according to the surgeon's preference. In most cases Physiopedia articles are a secondary source and so should not be used as references. x][s~wgRD-UIz73Zy H$'KF/q~no=mwqw_\W/"(n>|AGHDEE*n>|Qb//_|o8OL}u8fL5QKTa^D&OkNS`$4WqEyj_,2 9v4uq63L_@H88U0L'Zt'WK[u^R-`LU$RX~\ouPXkI,g: +n;HTfC*7R.L,_{*./`>>='hK~ The incision is in line with the femur and it goes from 5cm proximal to greater trochanter to 10cm distal to the greater trochanter. Make a longitudinal incision through the skin and subcutaneous tissue, with its proximal end directed slightly posteriorly. Precautions include: This 2 minute video reviews the three main hip precautions used for several weeks after posterior THR to prevent complications such as dislocation. Do not step backwards with surgical leg. . Dr. Wheeless enjoys and performs all types of orthopaedic surgery but is renowned for his expertise in total joint arthroplasty (Hip and Knee replacement) as well as complex joint infections. Insert suction drains if desired. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. Hip ReplacementHip Replacement, Resurfacing, Revision. Make a T-shaped incision in the capsule, if necessary, for exposure. Scar tissue due to previous exposure might obscure typical landmarks. - dislocations may occur in upto 20% of alcoholics who undergo THR via a posterior approach; Remove bursal tissue over the trochanter as needed. Muscle, Do not allow surgical leg to externally rotate (turn outwards). No crossing legs with the Posterior Approach: No crossing the legs is probably the most confusing instruction my patients receive.See my article on No Crossing The Legs.. You will need to detach the muscles from the greater trochanter either by sharp dissection or by lifting off a small flake of bone. detach fibers of gluteus medius that attach to fascia lata using . - lateral position, with a sterile surgical drape folded in a "saddle bag" fashion to allow the leg to hang over the edge of the table in a flexed and externally rotated position (inside of the saddle bag); We used this modified SPAIRE approach as this patient lives in a 'Mahjong' center . Hospital for Special Surgery. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4536510/, https://www.ncbi.nlm.nih.gov/books/NBK537031/. When refering to evidence in academic writing, you should always try to reference the primary (original) source. The anterolateral approach in total hip arthroplasty offers superb exposure that can be easily extended for complicated primary and revision surgery. We are compensated for referring traffic and business to companies linked to on this site. Do not cross your legs. Required fields are marked *, This renowned classic provides unparalleled coverage of manual muscle testing, plus evaluation and treatment of faulty and painful postural conditions. 44% of surgeons universally prescribing precautions while about one-third never prescribed precautions. The greater trochanter is reattached later by wires or cables. Abductor function after total hip replacement. longitudinal incision centered over tip of greater trochanter and extends down the line of the femur about 8cm. This information is provided as an educational service and is not intended to serve as medical advice. Direct Anterior Approach Total Hip Arthroplasty 10:21. 8. Hip precautions after total hip replacement and their discontinuation from practice: patient perceptions and experiences. Sterile dressing should be applied, and negative pressure incisional wound care can be considered. Distally, the anterior fibers of the vastus lateralis are elevated from the anterior femur. Patients who have undergone this procedure are usually able to walk unassisted the day after surgery, and leave the hospital without the typical restrictions (such as crossing their legs) associated with total hip replacement. The anterolateral approach (Watson-Jones) to the proximal femur, through the interval between glutei and tensor fasciae latae provides somewhat limited access to the hip joint along with the lateral proximal femur. Partial Hip Replacement. He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital. exclude forum, There are a variety of materials used to create the prosthetic components of an artificial hip. The incision can be prolonged distally over the proximal vastus lateralis to allow for insertion of plate fixation. Our mission is to share information and our experience, both as senior citizens and physical therapists, to help people age in place independently. Hip Precautions - Anterior Approach Available from: Harkess JW, Crockarell JR. Arthroplasty of the hip. Dr. Robert Donaldson, DC, PT. Split the fibers of the vastus lateralis muscle overlying the lateral aspect of the base of the greater trochanter. The posterior (also referred to as a Moore or Southern) approach allows the surgeon to access the hip joint from the back. Dislocation Precautions: Dislocation precautions are based on surgical approach and the direction in which the hip is dislocated intra-operatively (if at all) to gain exposure to the joint. This restriction is in addition to the posterior approach restrictions because of the cutting or splitting of the hip abductors during surgery. . There are no muscles that are cut during this procedure but the front of the joint capsule must be cut in order to access the femoral head and socket. Your email address will not be published. Many surgeons usually use a preferred approach to the hip for routine hip operations. How To Generate Retirement Income: Cash In On Your Knowledge. PRECAUTIONS X 6 WEEKS Wear TED Hose Sleep on back Pillow under ankle, NOT under knee - keep foot of bed flat Pillow between legs while sleeping No active Abduction exercises No straight leg raise (SLR) No Flexion > 90 degrees No ER > 30 degrees No Extension > 30 degrees No Adduction past midline POST-OP WEEKS 1 - 6 Incise the fat and underlying deep fascia in line with the skin incision. Start the slightly anteriorly curved skin incision about 7-10 cm proximal of the lateral part of the greater trochanter (directed towards the tubercle of the iliac crest the posterior landmark of tensor fasciae latae origin). The proximal part of the incision is limited by the superior gluteal nerve and vessels, crossing 35 cm proximal to the tip of the greater trochanter. 4, 5 The . 2023 Lineage Medical, Inc. All rights reserved, Hip Direct Lateral Approach (Hardinge, Transgluteal), Approaches | Hip Direct Lateral Approach (Hardinge, Transgluteal), has lower rate of total hip prosthetic dislocations, begin 5cm proximal to tip of greater trochanter, longitudinal incision centered over tip of greater trochanter and extends down the line of the femur about 8cm, detach fibers of gluteus medius that attach to fascia lata using sharp dissection, split fibers of gluteus mediuslongitudinally starting at middle of greater trochanter, do not extend more than 3-5 cm above greater trochanter to prevent injury to, extend incison inferior through the fibers of, anterior aspect of gluteus medius from anterior greater trochanter with its underlying gluteus minimus, requires sharp dissection of muscles off bone or lifting small fleck of bone, follow dissection anteriorly along greater trochanter and onto femoral neck which leads to capsule, gluteus minimus needs to be released from anterior greater trochanter, runs between gluteus medius and minimus 3-5 cm above greater trochanter, limiting proximal incision of gluteus medius, most lateral structure in neurovascular bundle of anterior thigh, keep retractors on bone with no soft tissue under to prevent iatrogenic injury, - Hip Direct Lateral Approach (Hardinge, Transgluteal), Shoulder Anterior (Deltopectoral) Approach, Shoulder Lateral (Deltoid Splitting) Approach, Shoulder Arthroscopy: Indications & Approach, Anterior (Brachialis Splitting) Approach to Humerus, Posterior Approach to the Acetabulum (Kocher-Langenbeck), Extensile (extended iliofemoral) Approach to Acetabulum, Hip Anterolateral Approach (Watson-Jones), Hip Posterior Approach (Moore or Southern), Anteromedial Approach to Medial Malleolus and Ankle, Posteromedial Approach to Medial Malleolus, Gatellier Posterolateral Approach to Ankle, Tarsus and Ankle Kocher (Lateral) Approach, Ollier's Lateral Approach to the Hindfoot, Medial approach to MTP joint of great toe, Dorsomedial Approach to MTP Joint of Great Toe, Posterior Approach to Thoracolumbar Spine, Retroperitoneal (Anterolateral) Approach to the Lumbar Spine. easier with leg flexed slightly. Hardinge Approach to Hip Joint indications. Close the subcutaneous tissue and skin as desired. The fascia can be too tight, where your assistant can abduct or lift the leg away to make it easier. The capsule is one of the primary dislocation prevention structures, so care is taken by restricting range-of-motion until the capsule is well healed and capable of resisting dislocation. 110 West Rd., Suite 227 An EMG and clinical review. The solution is to ALWAY lead with the operated leg when turning toward the operated side. Patients undergoing THA at our institution are informed of the requirement to follow hip precautions at multiple points during their pre-operative screening, admission . UCLA health. A surgical incision, approximately 6 cm in size, is made to the anterolateral side of the thigh to gain access to the hip joint. If the hip replacement was done through the more traditional posterior or antero- lateral/Hardinge approach - most patients have hip precautions for upto 6-8 weeks. Because of the impaired accuracy which can occur because of lack of visualization of the joint, surgeons performing MIS generally use computer-assisted guidance systems. Retract the muscle inferiorly. - Checklist for THR This capsulotomy shows the prosthesis. - note that many patients will have a reduced hip flexion contracture under anesthesia, which will give the surgeon the false sense of having corrected the contracture; In the lateral approach (also known as a Hardinge approach), the hip abductors (gluteus medius and gluteus minimus) are elevated not cut to provide access to the joint. You will need to detach the insertion of the gluteus minimus tendon to the anterior part of the greater trochanter. Available from: I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. Organize in-house training events for your surgical staff, Hand Distal phalanges revision published. The direct lateral approach to the hip for arthroplasty. The lower leg is placed into a pocket made from sterile drapes. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> The motion that would put the new hip in this extreme extension with external rotation would be something like kneeling on the operated leg with the foot turned out, then moving body weight forward onto the opposite foot. Place a Hohmann retractor into the bone proximal to the hip capsule. Distally, the incision extends along the femur about 10 cm below the greater trochanter. Age In Place School is a division of Buena Physical Therapy Services, Inc. Superior gluteal nerve runs between gluteus medius and minimus muscles 3-5 cm above greater trochanter. It can be protected by limiting proximal incision of gluteus medius muscle and putting a stay suture at the apex of gluteal split. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). This mini-invasive approach, in which neither muscle nor tendon is divided, is developed using the space between the gluteus medius and the tensor fascia lata. Additionally, there are many variations of the Anterior, Posterior, and Lateral surgical approaches and each surgeon has their own range-of-motion restrictions.Always follow the surgeons specific range-of-motion restrictions, the surgeon is the only one that knows exactly what was done during the surgery. <>>> The standard approach used in our hospital for THR in NOF fractures is the modified Hardinge approach to the hip. This is counterintuitive to the normal way to get up from a chair by leaning forward and pushing up with the legs.The legs will continue to supply most of the muscle power to stand from sitting, but the arms become important to keep the trunk erect coming from sitting to standing. Login to view comments. The piriformis muscle and the short external rotators (tendons) are taken off the femur. Orthopaedic Specialists of North Carolina. When ascending, step first with the unaffected leg (the side that was not operated on). Additional retractors anteriorly and posteriorly will open the dissected interval. Scar tissue due to previous exposure might obscure typical landmarks. 4 0 obj Incise the fascia lata over the femur and extend this incision proximally along the posterior border of the tensor fascia lata. - residual abductor weakness and limp may occur post op if there is an avulsion of the repaired of anterior portion of abductors; With the greater trochanter and the gluteus medius muscle exposed, retract the tensor fascia lata anteriorly and the gluteus medius muscle posteriorly. Do not go more than 3 cm above the upper border of the trochanter because more proximal dissection may damage branches of the superior gluteal nerve. Sleep on your surgical side when side lying. The anterior approach to total hip replacement has the least amount of restrictions of any of the total hip surgical approaches. Enter the capsule using a longitudinal T-shaped incision. The other is a very small incision in the thigh through which a special instrument is employed to work on the acetabulum (socket). But there is also more than one way to go about performing a hip replacement surgery - known as different "approaches.".
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