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Hip Arthroplasty - the Direct Anterior Approach without a Traction Table

February 01, 2013

Contributors: Martin Krismer, MD; David Putzer, MSc; Michael M Nogler, MD; Michael M Nogler, MD

Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.
Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.

In the past five year the direct anterior approach has become one of the standard approaches to total hip arthroplasty. It exploits the interval between tensor fasciae latae and rectus femoris muscle for total hip arthroplasty. This portal with a relatively short skin incision is used for acetabular as well as the preparation of the femur. The main advantage of this approach is the reduced muscle trauma which allows the gluteal muscles to be kept intact. This has immediate benefits and serves as long term muscle preservation. A reproducible surgical technique has been developed which guides the trainee through the procedure step by step. This Innsbruck Technique is not using any traction table but places the patient on a standard OR table. The video aims to teach the anatomy of the hip as seen from anterior and the DAA approach step by step, allowing the learner to reproduce each single step in surgery. Relevant steps are explained on a cadaver dissection and in live surgery. All necessary Instruments and its specific features are explained in detail and demonstrated in the video Anatomic structure used as landmarks or at risk are pointed out. Additional emphasize is put onto draping, patient positioning and personnel placement and patient handling in the intra-operative situation. Learning goals and key points are given at each section. A final section of the video is dedicated to possible complications and suggestions for salvage pathways. In anatomic specimens possible extensions of the approach are demonstrated.

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