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Exposure and Capsular Management in Anterior Total Hip Arthroplasty

March 15, 2015

Contributors: Jonathon Salava, MD; Jacob M. Drew, MD; J Bohannon Mason, MD; J Bohannon Mason, MD

This video presentation demonstrates the direct anterior (DA) approach for total hip arthroplasty (THA) with particular focus on safe delivery of the femur and meticulous preservation of the hip capsule. The senior surgeon in the video routinely performs THA via a DA approach that includes release of both the piriformis and the reflected head of the rectus femoris. The THA shown here is performed with the patient supine on a specialized table that allows for controlled hyperextension and external rotation of the femur. Following initial exposure, a wound protector allows for preservation of the anterior musculature. Precise retractor placement is emphasized to provide easy access for both acetabular and femoral preparation while minimizing soft-tissue trauma. Advanced capsular management strategies, including the "Close the Door" technique, achieve femoral exposure without compromising essential structures. Using this reproducible technique, THA can be performed safely with anatomic restoration of the soft tissues upon closure.

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