RU2815153C1 - Method of hip replacement with application of direct anterior approach - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics, and can be used for hip replacement with application of direct anterior approach. Method involves making a skin incision for length of 8–10 cm parallel to the direction of the inguinal fold, which is made 3 fingers distal from the anterior superior iliac spine, lateral to the line drawn from the anterior superior iliac spine in the distal direction and the corresponding projection of the intermuscular space between the fascia lata tensioner and the sartorius muscle. After opening the space between the fascia lata tensioner and the sartorius muscle, the rectus femoris muscle is retracted medially, followed by coagulation of the ascending branch of the lateral artery enveloping the hip. Deep leaf of the own hip fascia is dissected and a capsule of the hip joint is exposed on which an anterior L-shaped capsulotomy is performed. Osteotomy of a femoral neck is performed. Femoral head is removed by means of a screwed-in corkscrew. Capsule is released including an upper and an inferior capsulotomy. Acetabular cavity is prepared. Cotyloid component is inserted, during which the femur is displaced posteriorly with the help of a posterior retractor. Further, a femoral medullary canal is prepared and an endoprosthesis leg is inserted, during which the femoral bone is exposed while pulling the bone hook in an anterior and lateral direction. Thereafter, the proximal femur is fixed in an elevated position with the retractor placed at the level of the capsule release. Operated limb is placed under the contralateral limb in a reduced position with external rotation. Thereafter, a medullary canal of the proximal femur is opened. Bed for an endoprosthesis leg is formed. Test femoral component is installed, and when the results of the assessment tests and the length of the extremities are achieved, an implant is installed. For the purpose of the lower capsulotomy, the operated extremity of the patient is placed over the contralateral extremity to provide external rotation. For the upper capsulotomy, the operated extremity is placed in a neutral position, while the bone hook is used to elevate the hip by bringing the instrument into the medullary canal behind the calcar part of the femur after osteotomy. Acetabular cavity is prepared with the help of cutters. Endoprosthesis stem bed is formed with rasps and two offset adapters to the planned implant size. Medullary canal of the proximal femur is opened with a box chisel.

EFFECT: method provides less severity of pain syndrome and, as a result, reduces the need for prescription of opioid analgesics due to short incision length, absence of damage to fascia lata and muscle straining fascia lata and muscles of deltoid group of hip.

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Description

The invention relates to the field of medicine, namely to traumatology, orthopedics and rehabilitation, and discloses a method for hip replacement using direct anterior access.

Known from the prior art is a METHOD FOR ENDOPROSTHETICS OF THE HIP JOINT IN PATIENTS WITH RHEUMATOID ARTHRITIS [RU 2759075 C1 dated 06/09/2021], which includes performing surgical access to the hip joint under anesthesia, then partially excising the joint capsule, performing an osteotomy of the femoral neck, removing the head, treating acetabulum cutters, the medullary canal of the femur with rasps, then install the components of the hip joint endoprosthesis, characterized in that the synovial membrane of the hip joint is excised, heat treated with an electric coagulator along the perimeter of the attachment of the joint capsule to the edge of the acetabulum and along the perimeter of the attachment of the joint capsule to the proximal femur .

The disadvantage of the analogue is a large skin incision covering several anatomical areas, which leads to an increase in the healing time of the postoperative wound, an increased risk of damage to anatomical structures such as blood vessels and nerves, and a decrease in the aesthetics of the postoperative scar.

Also known is the METHOD OF ENDOPROSTHETICS OF THE HIP JOINT BY ANTERIOR VERTICAL CAPSULE ACCESS WITH A MODIFIED INECTION WITH ANATOMICAL DIRECT LATERAL ACCESS (VITOSH ACCESS) [US 11273054 B2 dated 2022-03-15], including preservation under the patient's iliofemoral ligament and restoration of the patient's hip joint capsule by performing a fascial incision that curves along the posterior aspect of the patient's greater trochanter and ends at the inferior edge of said greater trochanter, thereby preventing splitting of the patient's vastus lateralis muscle, then lifting from the greater trochanter the anterolateral periosteum that connects to the patient's gluteus medius and vastus lateralis muscles, This is followed by continued elevation of the anterolateral periosteum in a proximal direction by splitting both the gluteus medius and the underlying gluteus minimus along their fibers and retracting the anterior portions of said gluteus medius and said underlying gluteus minimus, without performing any trochanteric osteotomy. , making a vertical capsular incision in the capsule of the hip joint in a place located anterior to the diaphysis of the patient's femur, starting from the basicervical line of the patient's femoral neck and continuing proximally along the longitudinal axis of the patient's body, leaving the fibers of the iliofemoral ligament intact and after installing the endoprosthesis to the patient, restoration of the hip joint capsule and reinstallation of the patient's anterior musculoperiosteal flap by suturing it to the greater trochanter.

The disadvantage of the analogue is a large skin incision covering several anatomical areas, which leads to an increase in the healing time of the postoperative wound, an increased risk of damage to anatomical structures such as blood vessels and nerves, and a decrease in the aesthetics of the postoperative scar.

The closest in technical essence is the METHOD OF SURGICAL ACCESS TO THE HEAD OF THE FEMORUM OF THE HIP JOINT [RU 2008152641 A dated December 31, 2008], which includes making a skin incision along the anterior third of the iliac crest with a rotation down the anterior surface of the thigh to the level of the base of the greater trochanter, penetration between the sartorius muscle and the tensor fascia lata muscle with exposure of the anterior iliac spine, characterized in that an arcuate skin incision in the projection of the anterior iliac crest is made 15-18 cm long, then a layer-by-layer dissection of the subcutaneous fatty tissue, superficial fascia and the fascia proper of the thigh is performed, and with blunt and sharp penetration between the sartorius muscle and the tensor fascia lata muscle, the sartorius muscle is retracted medially, and the tensor fascia lata muscle is retracted laterally and posteriorly without crossing the neurovascular formations along the anterior outer surface of the hip joint, then a blunt penetration is performed between the iliopsoas muscle and the anterior section of the gluteus medius and minimus muscles, while the iliopsoas muscle is retracted medially along with the femoral neurovascular bundle, the gluteus medius and minimus muscles are retracted outward and posteriorly along with the superior gluteal neurovascular bundle, and the rectus femoris muscle found deep in the wound is retracted medially with exposure of the layer of pre-articular tissue as an internal landmark for identifying the capsule of the hip joint, a T-shaped dissection of the capsule of the hip joint along the anterior surface is performed with the base towards the acetabulum, exposing the head of the femur, which is dislocated from the acetabulum into the wound, then after completion of resection arthroplasty, it is washed and drain the surgical wound with a bipolar drainage carried out in the longitudinal direction over the surface of the resected hip joint, suturing the wound layer by layer and at the same time returning the allocated uncrossed muscles and neurovascular bundles to their anatomical places.

The main technical problem of the prototype is a large skin incision covering several anatomical areas, which leads to an increase in the healing time of the postoperative wound, an increased risk of damage to anatomical structures such as blood vessels and nerves, and a decrease in the aesthetics of the postoperative scar.

The objective of the invention is to eliminate the shortcomings of the prototype.

The technical result achieved in the invention is to reduce the rehabilitation period of patients by maintaining the integrity of muscles, tendons and neurovascular bundles in the operated area.

This technical result is achieved due to the fact that the method of hip joint replacement using direct anterior access involves making a skin incision 8-10 cm long parallel to the direction of the inguinal fold, which is made 3 fingers distal to the anterior superior iliac spine, lateral to the line drawn from the anterior superior iliac spine distally and the corresponding projection of the intermuscular space between the tensor fascia lata and the sartorius muscle, then after opening the space between the tensor fascia lata and the sartorius muscle, the rectus femoris muscle is retracted medially, after which the ascending branch of the lateral circumflex artery is coagulated, then dissection of the deep layer of the fascia of the femur is performed and the capsule of the hip joint is exposed, on which an anterior L-shaped capsulotomy is performed, then an osteotomy of the femoral neck is performed, after which the head of the femur is removed using a screw-in corkscrew, then the capsule is released, including the upper and lower capsulotomy, then the acetabular cavity is prepared, then the acetabular component is installed, during which the femur is shifted in the posterior direction using a posterior retractor, then the medullary canal of the femur is prepared and the endoprosthesis leg is installed, during which the femur is exposed by traction on the bone hook in the anterior and lateral direction, after which the proximal femur is fixed in an elevated position with a retractor installed at the level of the capsule release, then the operated limb is placed under the contralateral limb in an abducted position with external rotation, after which the medullary canal of the proximal femur is opened, then formed bed for the endoprosthesis stem, then the test femoral component is installed and, when the results of the evaluation tests and the length of the limbs are achieved, the implant is installed.

Specifically, for an inferior capsulotomy, the patient's operated limb is positioned over the contralateral limb to achieve external rotation.

In particular, for an upper capsulotomy, the operated limb is placed in a neutral position, and the femur is elevated with a bone hook, inserting the instrument into the medullary canal behind the calcar part of the femur after the osteotomy.

In particular, the preparation of the acetabular cavity is performed using cutters.

In particular, the bed for the endoprosthesis stem is formed with rasps and two offset adapters to the planned size of the implant.

In particular, the medullary canal of the proximal femur is opened with a box chisel.

The essence of the invention is illustrated by drawings

Brief description of drawings:

In fig. Figure 1 shows an algorithm for the method of hip replacement using direct anterior access.

In fig. Figure 2 shows a preoperative X-ray of patient K., 36 years old.

In fig. Figure 3 shows a postoperative X-ray of patient K., 36 years old.

In fig. Figure 4 shows a postoperative scar 10 days after endoprosthetics.

In fig. Figure 5 shows a preoperative X-ray of patient G., 53 years old.

In fig. Figure 6 shows a postoperative X-ray of patient G., 53 years old.

In fig. Figure 7 shows a postoperative X-ray of patient G., 53 years old.

In fig. Figure 8 shows a postoperative X-ray of patient R., 64 years old.

In fig. Figure 9 shows the postoperative scar on the 14th day after endoprosthetics.

The method of hip replacement using a direct anterior approach begins with a skin incision, which is made 3 fingers distal to the anterior superior iliac spine, the length of the incision is 8-10 cm, the direction of the incision is parallel to the direction of the inguinal fold. The skin incision is located lateral to the line drawn from the anterior superior iliac spine distally and the corresponding projection of the intermuscular space between the tensor fascia lata and the sartorius muscle (the specified intermuscular space is identified by palpation). Making the incision in this manner minimizes the risk of injury because the branching of the main trunk of the lateral femoral cutaneous nerve occurs medial to the anterior superior iliac spine. At the same time, the surgeon’s visualization is not impaired at all stages of endoprosthetics. Next, dissection of the subcutaneous fat is performed from coagulations of small vessels. After this, the belly of the tensor fascia lata is identified, then an incision is made in the superficial plate of the fascia propria. The next step is to digitally separate the fibers of the tensor fascia lata and the sartorius muscle, while the tensor fascia lata is retracted laterally and the sartorius muscle medially. After opening the space between the tensor fascia lata and the sartorius muscle, the rectus femoris muscle is visualized, from under which emerges the ascending branch of the lateral artery, which bends around the femur and lies on the deep layer of its own fascia. The rectus and sartorius muscles of the thigh are retracted medially and coagulation of the vascular bundle is performed. Next, the deep plate of the fascia propria is dissected.

Next, 3 main stages of the intervention are performed: capsule isolation, capsule release and installation of prosthetic components.

To isolate the capsule during surgery, a stable position of the retractors is established to minimize damage to the soft tissue. To hold the retractors in a stable position during the anterior direct approach on a conventional operating table, 2 operating assistants are required. For adequate visualization of the anterior capsule when isolating the latter, 4 retractors were used.

Release of the capsule begins with an anterior L-shaped capsulotomy, after which an osteotomy of the femoral neck is performed and the head is removed using a screw-in corkscrew (this action eliminates the stage of dislocation of the head performed when using a direct lateral approach and thereby reduces trauma to soft tissues and neurovascular bundles) , after which the capsule is released.

To determine the angle of inclination of the femoral neck osteotomy, use an anatomical landmark corresponding to the course of the fibers of the lateral head of the quadriceps femoris muscle - step back 3 mm and direct the saw blade parallel.

For an inferior capsulotomy (or pubofemoral ligament release), the patient's operated limb is placed on top of the contralateral limb to achieve external rotation. As a result of this action, the pubofemoral ligament and lesser trochanter become accessible for subsequent release. For an upper capsulotomy, the operated limb is placed in a neutral position, and the femur is elevated with a bone hook by inserting the instrument into the medullary canal behind the calcar part after the osteotomy, which allows the femur to be pulled in the lateral and anterior direction. This maneuver allows the operating surgeon to clearly perform the release and determine the moment of its completion.

Visualization of the acetabulum is improved after capsule release. The femur is displaced posteriorly using a posterior retractor. Using the posteroinferior retractor, the transverse acetabular ligament is exposed. The acetabular cavity is prepared using conventional or offset cutters. The remains of the round ligament of the femoral head and the acetabular lip are removed.

This is followed by the process of preparing the femoral canal, during which the femur is exposed by traction on the bone hook in an anterior and lateral direction. This allows the soft tissue to be retracted with the femoral retractor. The retractor is placed at the level of the capsule release and essentially ensures that the proximal femur is positioned in an elevated position. The operated limb is placed under the contralateral one in an abducted position with external rotation. A second retractor is used to expose the posteromedial femur to visualize the proximal femur and protect the soft tissue. Opening the medullary canal of the proximal femur is performed with a box-shaped chisel. The bed for the endoprosthesis stem is formed with rasps and two offset adapters to the planned size of the implant.

Next, the test femoral component is installed, followed by assessment of the length of the limbs, determination of the range of motion and stability of the components of the endoprosthesis for dislocation. When the required results of assessment tests and limb length were achieved, a decision was made to install an implant.

The most important advantage of the access is the ability to assess the stability of the joint and the length of the limb, which is carried out during the operation before the final installation of the implant and closure of the surgical wound, performing such manipulations as:

-impact load test and stability assessment at deep flexion, medium flexion and extension;

- assessment of limb length by ankle height and using the Galleazzi test.

The technical result claimed in the invention is achieved due to the fact that the method of hip arthroplasty using direct anterior access, when used, provides an approach to the anterior surface of the hip joint without crossing and without damaging the muscles and at the same time ensures bypass of all major vessels during surgical access. -nervous formations along the anterior outer surface of the hip joint. A significant acceleration in the activation of patients was recorded. Thus, patients can get up independently within 6 hours after surgery. The minimally invasive and low-traumatic approach significantly reduces the severity of pain, which allows the surgeon not to prescribe opioid analgesia. It was found that in the first 3 months after surgery, the approach is characterized by the most satisfactory results of the function of the hip joint, compared with the use of other surgical approaches to the hip joint during endoprosthetics.

An example of the implementation of the proposed method of hip replacement using direct anterior access is the following clinical examples:

Example 1.

Patient K., 36 years old, was admitted to the hospital with a diagnosis of stage 4 bilateral aseptic necrosis of the femoral heads.

At the time of admission, he complained of unbearable pain and severe limitation of movements in both hip joints, inability to move without the help of crutches and relatives, and a significant decrease in quality of life. The patient also noted a significant increase in pain over the past six months, the inability to sleep without taking painkillers, and a decrease in quality of life during everyday activities.

History: suffered a coronavirus infection in July 2021, treatment with corticosteroids, exercises moderately, suffers from excess weight (height 185 cm, weight 114 kg, 1st degree obesity). I began to notice pain in both hip joints over the past year. He underwent a course of therapeutic physical training and was treated at the place of residence using conservative methods - without significant improvement. There are no chronic diseases.

Clinically: he moves with the use of additional support - crutches, the range of movements in the right and left hip joints is sharply reduced, severe pain during passive and active movements. Shortening of the right lower limb by 1 cm, shortening of the left lower limb by 1.5 cm.

Taking into account complaints, anamnesis, clinical manifestations and x-ray pictures, a decision was made to perform simultaneous bilateral hip arthroplasty.

The operation was performed in accordance with the method of hip replacement using a direct anterior approach, which included a skin incision made 3 fingers distal to the anterior superior iliac spine, lateral to a line drawn from the anterior superior iliac spine distally and the corresponding projection of the intermuscular space between tensor fasciae lata and the sartorius muscle, the length of the incision was 8 cm, the direction of the incision was parallel to the direction of the inguinal fold, after opening the space between the tensor fascia lata and the sartorius muscle, the rectus femoris muscle was retracted medially, after which coagulation of the ascending branch of the lateral circumflex femoral artery was performed. dissection of the deep layer of the fascia of the femur and came out to the capsule of the hip joint, the release of the capsule began with an anterior L-shaped capsulotomy, then an osteotomy of the femoral neck was performed, after which the head of the femur was removed using a screw-in corkscrew, then the capsule was released, for the lower capsulotomy the operated the patient's limb was placed on top of the contralateral limb to ensure external rotation; for the upper capsulotomy, the operated limb was placed in a neutral position, and the femur was elevated with a bone hook, inserting the instrument into the medullary canal behind the calcar part of the femur after osteotomy, then the acetabular cavity was prepared using conventional or offset cutters, then the installation of the acetabular component was performed, during which the femur was shifted in the posterior direction using a posterior retractor, then the medullary canal of the femur was prepared and the leg of the endoprosthesis was installed, during which the following was performed: exposure of the femur by traction on the bone hook in the anterior and in the lateral direction, after which the proximal femur was fixed in an elevated position with a retractor installed at the level of the capsule release, then the operated limb was placed under the contralateral limb in an abducted position with external rotation, after which the medullary canal of the proximal femur was opened with a box-shaped chisel, then the bed for the leg The endoprosthesis was formed with rasps and two offset adapters to the planned size of the implant, then the test femoral component was installed, and when the required results of the evaluation tests and limb length were achieved, the implant was installed.

X-ray results:

Fig. 2 - Preoperative X-ray of patient K., 36 years old.

Figure 3 - Postoperative X-ray of patient K., 36 years old.

Figure 4 - Postoperative scars 10 days after endoprosthetics.

4 days after the operation, the patient was discharged from the hospital. A week later, the patient noted a significant decrease in pain. 10 days after the operation, the patient began to move independently and returned to an active lifestyle.

Example 2.

Patient G., 53 years old, was admitted to the hospital with a diagnosis of bilateral aseptic necrosis of the femoral heads.

At the time of admission, she complained of constant severe pain in the hip joint, radiating to the groin area, more on the right; recently she noted the presence of night pain that disturbed sleep; complaints about the inability to lead an active lifestyle.

History: long-term static loads on the hip joints, previous coronavirus infection, treatment with corticosteroids, walking with crutches for half a year. Conservative therapy did not bring results.

Clinically: he moves with the help of crutches, lameness in both limbs, a marked decrease in the range of motion in both hip joints: limited rotation, adduction, abduction of the limb, impaired flexion and extension of the limb in the hip joints. Upon examination, a decrease in the volume of the hips on both sides and flattening of the buttocks are determined.

A decision was made to perform bilateral hip arthroplasty. The interval between the two operations was 1 month.

The operation was performed in accordance with the method of hip replacement using a direct anterior approach, which included a skin incision made 3 fingers distal to the anterior superior iliac spine, lateral to a line drawn from the anterior superior iliac spine distally and the corresponding projection of the intermuscular space between tensor fascia lata and the sartorius muscle, the length of the incision was 9 cm, the direction of the incision was parallel to the direction of the inguinal fold, after opening the space between the tensor fascia lata and the sartorius muscle, the rectus femoris muscle was retracted medially, after which coagulation of the ascending branch of the lateral circumflex femoral artery was performed. dissection of the deep layer of the fascia of the femur and came out to the capsule of the hip joint, the release of the capsule began with an anterior L-shaped capsulotomy, then an osteotomy of the femoral neck was performed, after which the head of the femur was removed using a screw-in corkscrew, then the capsule was released, for the lower capsulotomy the operated the patient's limb was placed on top of the contralateral limb to ensure external rotation; for the upper capsulotomy, the operated limb was placed in a neutral position, and the femur was elevated with a bone hook, inserting the instrument into the medullary canal behind the calcar part of the femur after osteotomy, then the acetabular cavity was prepared using conventional or offset cutters, then the installation of the acetabular component was performed, during which the femur was shifted in the posterior direction using a posterior retractor, then the medullary canal of the femur was prepared and the leg of the endoprosthesis was installed, during which the following was performed: exposure of the femur by traction on the bone hook in the anterior and in the lateral direction, after which the proximal femur was fixed in an elevated position with a retractor installed at the level of the capsule release, then the operated limb was placed under the contralateral limb in an abducted position with external rotation, after which the medullary canal of the proximal femur was opened with a box-shaped chisel, then the bed for the leg The endoprosthesis was formed with rasps and two offset adapters to the planned size of the implant, then the test femoral component was installed, and when the required results of the evaluation tests and limb length were achieved, the implant was installed.

X-ray results:

Fig. 5 - Preoperative X-ray image of patient G., 53 years old.

Fig. 6 - Postoperative X-ray of patient G., 53 years old.

Fig. 7 - Postoperative X-ray of patient G., 53 years old

After endoprosthesis replacement on the right hip joint, the patient was discharged from the hospital on the 5th day, and began to move independently without the help of crutches on the 11th day after surgery. 1 month after surgery, endoprosthetics of the left hip joint was performed. The patient was discharged from the hospital on the 6th day after the operation, and began to move independently on the 12th day after the intervention.

Example 3.

Patient R., 64 years old, was admitted to the hospital with a diagnosis of bilateral coxarthrosis, stage 3 on the left, stage 2 on the right.

At the time of admission, she complained of pain in the left hip joint radiating to the groin area and knee joint on the affected side. The pain intensifies towards the end of the day and after physical activity. She also complained of limping on the affected side, decreased quality of life, and walking with the support of a cane.

History: she has been suffering from pain in the left hip joint for 10 years; for the last two years she has been regularly taking painkillers - ketorol, diclofenac retard tablets, but over the last six months the analgesic effect of the drugs has decreased.

Clinically: severe pain in the left hip joint, positive Tradelenburg test on the left, decreased range of motion in both hip joints, more in the left, movement with the help of crutches.

A decision was made to undergo endoprosthesis replacement of the left hip joint.

The operation was performed in accordance with the method of hip replacement using a direct anterior approach, which included a skin incision made 3 fingers distal to the anterior superior iliac spine, lateral to a line drawn from the anterior superior iliac spine distally and the corresponding projection of the intermuscular space between tensor fascia lata and the sartorius muscle, the length of the incision was 10 cm, the direction of the incision was parallel to the direction of the inguinal fold, after opening the space between the tensor fascia lata and the sartorius muscle, the rectus femoris muscle was retracted medially, after which coagulation of the ascending branch of the lateral circumflex femoral artery was performed. dissection of the deep layer of the fascia of the femur and came out to the capsule of the hip joint, the release of the capsule began with an anterior L-shaped capsulotomy, then an osteotomy of the femoral neck was performed, after which the head of the femur was removed using a screw-in corkscrew, then the capsule was released, for the lower capsulotomy the operated the patient's limb was placed on top of the contralateral limb to ensure external rotation; for the upper capsulotomy, the operated limb was placed in a neutral position, and the femur was elevated with a bone hook, inserting the instrument into the medullary canal behind the calcar part of the femur after osteotomy, then the acetabular cavity was prepared using conventional or offset cutters, then the installation of the acetabular component was performed, during which the femur was shifted in the posterior direction using a posterior retractor, then the medullary canal of the femur was prepared and the leg of the endoprosthesis was installed, during which the following was performed: exposure of the femur by traction on the bone hook in the anterior and in the lateral direction, after which the proximal femur was fixed in an elevated position with a retractor installed at the level of the capsule release, then the operated limb was placed under the contralateral limb in an abducted position with external rotation, after which the medullary canal of the proximal femur was opened with a box-shaped chisel, then the bed for the leg The endoprosthesis was formed with rasps and two offset adapters to the planned size of the implant, then the test femoral component was installed, and when the required results of the evaluation tests and limb length were achieved, the implant was installed.

Fig. 8 - Postoperative X-ray image of patient R., 64 years old.

Fig. 9 - Postoperative scar on the 14th day after endoprosthetics.

The patient was discharged from the hospital on the 4th day after surgery, on the 10th day she noted the absence of pain in the area of the replaced joint, and on the 12th day she began to move without the help of crutches.

The advantages of the method of hip replacement using direct anterior access are the short length of the skin incision, low volume of blood loss, no damage to the fascia lata and the tensor fascia lata muscle, no damage to the muscles of the deltoid group of the thigh (small, middle, large) when removing the femoral head bones are not damaged by muscles during traction and dislocation, the position of the patient on his back allows for control of the restoration of limb length, ease of implementation for the specialists of the operating team; facilitates the taking of x-rays, ensures good stability of the implant, while reducing the risk of dislocation, facilitates the measurement of limb length, reduces the risk of muscle damage and, accordingly, the incidence of postoperative atrophy and muscle dysfunction, helps to increase patient mobility in the early postoperative period, helps reduce the duration of hospitalization and accelerates the rehabilitation of patients after surgery, provides less pain and, as a result, reduces the need to prescribe opioid analgesics.

Claims (21)

1. A method of hip replacement using direct anterior access, containing making a skin incision for a length of 8-10 cm parallel to the direction of the inguinal fold, which is made 3 fingers distal to the anterior superior iliac spine, lateral to a line drawn from the anterior superior iliac spine distally and the corresponding projection of the intermuscular space between the tensor fasciae lata and the sartorius muscle, then, after opening the space between the tensor fascia lata and the sartorius muscle, the rectus femoris muscle is retracted medially, after which the ascending branch of the lateral femoral circumflex artery is coagulated, Next, a dissection of the deep layer of the fascia of the thigh is performed and the capsule of the hip joint is exposed, on which an anterior L-shaped capsulotomy is performed, then an osteotomy of the femoral neck is performed, after which the head of the femur is removed using a screw-in corkscrew, then the capsule is released, including upper and lower capsulotomy, Next, the acetabular cavity is prepared, Next, the acetabular component is installed, during which the femur is shifted posteriorly using a posterior retractor, Next, the medullary canal of the femur is prepared and the leg of the endoprosthesis is installed, during which the femur is exposed by traction on the bone hook in the anterior and lateral direction, after this, the proximal femur is fixed in an elevated position with the retractor installed at the level of the capsule release, then the operated limb is placed under the contralateral limb in an abducted position with external rotation, after this, the medullary canal of the proximal femur is opened, then a bed for the endoprosthesis leg is formed, then the test femoral component is installed and, when the results of the evaluation tests and limb length are achieved, the implant is installed. 2. The method of hip replacement using direct anterior access according to claim 1, characterized in that for lower capsulotomy, the patient’s operated limb is placed on top of the contralateral limb to ensure external rotation. 3. The method of hip replacement using direct anterior access according to claim 1, characterized in that for the upper capsulotomy the operated limb is placed in a neutral position, and the hip is elevated with a bone hook, inserting the instrument into the medullary canal behind the calcar part of the femur after the osteotomy. 4. The method of hip replacement using direct anterior access according to claim 1, characterized in that the acetabular socket is prepared using cutters. 5. The method of hip replacement using direct anterior access according to claim 1, characterized in that the bed for the endoprosthesis stem is formed with rasps and two offset adapters to the planned size of the implant. 6. The method of hip replacement using direct anterior access according to claim 1, characterized in that the medullary canal of the proximal femur is opened with a box-shaped chisel.