Approaches in Hip Resurfacing by Dr. Gross

The path that surgeons choose to arrive at the hip joint is called the
"approach". There are many different basic approaches used for hip resurfacing.
None has been proven to be superior to others based on valid scientific
research. Basically, I recommend that a surgeon use the method that he/she is
already most comfortable with when performing standard total hip replacement and
modify it as needed for the more complex hip resurfacing operation. My preferred
approach is the posterior. This is used in at least 70% of hip resurfacings done
worldwide. The next most common approach is the lateral (two … Read the rest

Dr. Gross discusses the Gantz vs other surgical approaches

Approaches in hip resurfacing

The path that surgeons choose to arrive at the hip joint is called the
"approach". There are many different basic approaches used for hip resurfacing.
None has been proven to be superior to others based on valid scientific
research. Basically, I recommend that a surgeon use the method that he/she is
already most comfortable with when performing standard total hip replacement and
modify it as needed for the more complex hip resurfacing operation. My preferred
approach is the posterior. This is used in at least 70% of hip resurfacings done
worldwide. The next most common approach … Read the rest

Dr. Rogerson Compares the Posterior Approach & Gantz Approach

I am not enthused about the Ganz trochanteric flip approach for several reasons. It was developed to be less injurious to the femoral blood supply. Koen DeSmet showed that with the modified posterior capsulotomy approach that he, Bose and I use that the blood supply compromise during is not much different than with a trochanteric osteotomy. Also, the incidence of AVN even with the much more extensive posterior capsular release that McMinn initially used is extremely low. We are now over 600 cases and have not seen a case of AVN.

Problems with any trochanteric osteotomy including the trochanteric flip … Read the rest

Dr. Bose Compares Posterior Approach to Gantz Approach

Comments by Dr. Vijay Bose

The ganz trochanteric flip is an excellent approach for doing open FAI surgery, for fixing fracture on the femoral head ( pipkin #) and for doing osteotomy of the femoral neck in post SUFE situations. In these non – arthritic situations a surgical dislocation of the hip is warranted without damaging the blood supply and I employ it routinely for these indications.

However its use in hip resurfacing is a bit of an overkill. It has been documented without a shadow of doubt that the post approach does not compromise the vascularity of the femoral … Read the rest

Dr. Brooks Compares theGanz Approach vs Other Surgical Approaches

Hi Pat,

You asked about the Ganz approach, which is also known as “surgical dislocation” of the hip for resurfacing.

This was described way back in 2001 by Prof. Reinhold Ganz in Berne, Switzerland. Resurfacing was being done in those days, although not so much by him, and he used it for all kinds of hip surgery from debridement to revision total hips. The key factor is that it is designed to preserve the blood supply to the femoral head. That is irrelevant in hip replacement because the femoral head is getting cut off anyway. In joint preservation procedures like … Read the rest

A Modified Posterior Approach Preserves Femoral Head Oxgenation During Hip 2010

A Modified Posterior Approach Preserves Femoral Head Oxgenation During Hip
Resurfacing 2010

Steffen RT, De Smet KA, Murray DW, Gill HS  2010 Mar 22

Original Link 

http://www.ncbi.nlm.nih.gov/pubmed/20334994?dopt=AbstractPlus

Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences,
University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK.

In 11 patients, the oxygenation was measured in the superolateral quadrant of
the femoral head during resurfacing with a modified posterior approach, designed
to preserve the blood supply, using a gas-sensitive electrode. These were
compared with measures from 10 patients in whom the standard posterior approach
was used. The modified approach patients maintained a significantly (P < … Read the rest

Dr. De Smet Discusses Computer Assisted Surgery for Hip Resurfacing

WHAT ABOUT NAVIGATION

Today navigation is still a tool that is not easy to use and
that needs a certain learning curve as resurfacing itself
also has.

So it is not a useful tool today for resurfacing beginners,
where it should be! It would be nice if it would be a help
at the start of the learning curve.

So can somebody with experience use it or should they use
it?

It is like doing a certain approach and having experience
with it, so it feels better and confident.

Most of the experienced surgeons do feel they do not need… Read the rest

Dr. Schmalzried Discusses Computer Navigation for Hip Resurfacing

There is some data indicating that navigation can improve
the accuracy of femoral component placement in hip
resurfacing.  The real issue is "compared to what?"  For an
inexperienced surgeon, navigation may help him avoid
component positioning problems that have been associated
with "the learning curve".  However, for an experienced
surgeon, who has an established mechanical alignment system
with a high success rate – it is difficult to demonstrate an
advantage to him with a navigation system.  Further, the
registration process takes a little time – so the
cost-to-benefit ratio for the experienced surgeon in a busy O.R. is questionable.  The … Read the rest