Tips and tricks for posterior approach.
|Soft tissue management||• We encourage a minimally-invasive approach with preservation of piriformis tendon.|
|• No specific recommendations for closing and reconstructing of the joint capsule and external rotator muscles.|
|• Keep the transverse acetabular ligament intact to determine the acetabulum version.|
|Acetabulum preparation||• Requires a good acetabular exposure.|
|• Start by reaming vertically with a small diameter reamer in order to remove all the osteophytes around the acetabular fossae.|
|• The inferior edge of the reamer is then placed in line with the transverse acetabular ligament to respect anatomic anteversion.|
|• Try to use smallest cup size that will allow a good primary fixation.|
|Cup positioning||• Keep a sufficient anteversion to avoid psoas impingement and decrease the risk of dislocation.|
|• A supero-posterior bone coverage defect of the cup is often observed and has no consequences.|
|Intraoperative testing||• For stability tests, the hip is flexed at 90° and an internal rotation is gradually applied. If dislocation occurs at more than 45°, the THA is considered stable.|
|• For length and femoral offset parameters, the piston sign observed with knee fully extended has to disappear when the knee is flexed at 90° of flexion.|
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