{"playlist":"https:\/\/content.jwplatform.com\/feeds\/IwFksVzC.json","ph":2} . The fascia can be too tight, where your assistant can abduct or lift the leg away to make it easier. Hardinge Approach to Hip Joint (Direct Lateral Approach) cannot be extended proximally. Proximally, this extends into the tendinous insertion of gluteus medius and splitting fibers of vastus lateralis distally. 44% of surgeons universally prescribing precautions while about one-third never prescribed precautions. - superior gluteal nerve enters posterior surface of this muscle and is at risk for injury (if dissection is carried too far proximally); Hospital for Special Surgery. Deepen the incision through the gluteus medius and minimus proximally, retracting the anterior flap to show the hip capsule superiorly and adjacent supraacetabular ilium. Patients undergoing THA at our institution are informed of the requirement to follow hip precautions at multiple points during their pre-operative screening, admission . Are you sure you want to trigger topic in your Anconeus AI algorithm? Another place my posterior approach hip replacement patients break the no hip flexion past 90-degree rule is when they are sitting on the commode. The lateral aspect of the greater trochanter. Translateral surgical approach to the hip. The greater trochanter at the upper end of the femur may also be cut in this approach (also referred to as an osteotomy), which greatly increases the exposure of the hip joint. Filed Under: Are you sure you want to trigger topic in your Anconeus AI algorithm? We are then going to cut straight across the tendon where it inserts into the greater trochanter but leave enough cuff on both sides so as to repair it later. <> See My Other Total Hip Replacement Articles: How To Choose A Surgeon For Hip ReplacementSpeed Up Recovery After Total Hip ReplacementCan I Sit In A Recliner After Hip ReplacementCrossing Legs After Total Hip Surgery: (A PTs Complete Guide)Stairs After Total Hip Replacement: A Physical Therapy GuideIce After Total Knee Replacement: A PTs Complete Guide. We are compensated for referring traffic and business to companies linked to on this site. . Choosing the optimal surgical approach can minimize these risks and therefore improve the outcome of THA. - prior to applying the femoral head, consider applying a trial head to be sure that stability is optimal; The incision can be prolonged distally over the proximal vastus lateralis to allow for insertion of plate fixation. Robotic Assisted Total Hip Replacement. Web site http:// www.orthoanswer.org/hip/total-hip-replacement/recovery.html. Recent evidence suggests hip precautions provide no added benefits. Now feel the greater trochanter and place the incision. Damage to the superior gluteal nerve after the Hardinge approach to the hip. It exposes the femur well with good access to the joint. The approach can be extended distally, for adequate exposure of the fracture. Begin the incision 5 cm above the tip of the greater trochanter. The size of the components was determined on the basis of preoperative template measurements and intraoperative assessment. No internal rotation with the Posterior Approach: The most common way that rule is broken is by pivoting on the operated leg when turning in that direction. Age In Place School is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com. Damage to the superior gluteal nerve after the Hardinge approach to the hip. 1. Because of the impaired accuracy which can occur because of lack of visualization of the joint, surgeons performing MIS generally use computer-assisted guidance systems. Traditionally, protocols describing these restrictions and precautions require patients to sleep supine (usually with an abduction pillow in place), to use walking aids for several weeks, only to sit on high chairs and not to sit cross-legged, not to bend forward or to flex their hip joint beyond 90. Many of my patients with a posterior total hip replacement decide to get an electrical lift recliner chair to eliminate the difficulty of coming from sitting in a recliner chair to standing erect. As a licensed physical therapist I have seen hundreds, if not thousands, of total hip replacement surgeries over the more than 4 decades of treating patients as a hospital-based physical therapist, outpatient physical therapy owner/operator, and for the past several years seeing total hip replacement patients in their homes just a day or two after their surgeries. You are in: Home Approach Hip Approaches Hardinge Approach. Advance to treadmill D. Recommended long-term activities after Total Hip Replacement (DeAndrade, KJ - Activities after replacement of the hip or knee, Orthopedic Special Edition 2(6):8, 1993) The proximal part of the incision is limited by the superior gluteal nerve and vessels, crossing 3-5 cm proximal to the tip of the greater . This can be best done by blunt dissection. Recovery and Rehabilitation: Western Health; 2013. How To Generate Retirement Income: Cash In On Your Knowledge. Be aware of vessels running across this interval. This 1 minute video shows the precautions. You will need to detach the muscles from the greater trochanter either by sharp dissection or by lifting off a small flake of bone. Copyright@orthopaedicprinciples.com. The provocative position for hip dislocation is: hip extension, external rotation. begin 5cm proximal to tip of greater trochanter. UCLA health. - significant hip flexion contracture: Expose the interval between the gluteus medius and the tensor fascia lata and extend it proximally over the hip joint. The approach does not give as wide an exposure as theanterolateral approach to hip jointwith trochanteric osteotomy. Our mission is to share information and our experience, both as senior citizens and physical therapists, to help people age in place independently. Dislocation after total hip arthroplasty using the anterolateral abductor split approach. x 9|1F:MZCqb~/5I:2 Xlm/S6|]K-EL'i! ;tL+~>N"z!1/Cmc4gXR21MTK2y Patient positioning in case of anterolateral approach to the right hip -patient is on his left hand side, surgeon stands behind and looks down on the patients right hip which has been prepared. You will need to detach the insertion of the gluteus minimus tendon to the anterior part of the greater trochanter. This technique is a unique and innovative method of performing a hip replacement. [2] Hip precautions mainly apply to the posterior or posterior lateral hip replacement procedure. Total hip replacement. Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. Divide the gluteus medius into two imaginary thirds. The abductor muscle "split". The modified Hardinge anterior approach to total hip replacement is performed with you in the supine position. The vastus lateralis muscle is also split in its own line lateral to the point where it is supplied by the femoral nerve. And the hip is never dislocated. - unfortunately, many of these patients will re-gain their flexion contracture postoperatively; Exposure of the hip by anterior osteotomy of the greater trochanter. Incision. Posterior hip precautions Available from: Halton Healthcare. Comparison of heterotopic bone after anterolateral, transtrochanteric, and posterior approaches for total hip arthroplasty. Surgical approaches in THA include anterior, lateral [anterolateral (Hardinge) and direct lateral (Watson-Jones . The approaches are posterior (Moore or southern), lateral (Hardinge or Liverpool), antero-lateral (Watson-Jones), anterior (Smith-Petersen) and greater trochanter osteotomy. All arthroplasties were performed through a modified Hardinge anterolateral approach or direct anterior approach with the patient in the supine position. In most cases Physiopedia articles are a secondary source and so should not be used as references. Age In Place School is a participant in affiliate advertising programs designed to provide fees by advertising and linking to their products. This mistake can be avoided by placing a body pillow between the legs when lying on the unoperated side, but the operated leg MUST be supported from the groin to past the ankle. This site does not constitute medical advice. and place two retraction sutures, anteriorly and posteriorly. Hip ReplacementHip Replacement, Resurfacing, Revision. The different incisions used in a hip replacement surgery are all defined by their relation to the musculature of the hip. Comparison of heterotopic bone after anterolateral, transtrochanteric, and posterior approaches for total hip arthroplasty. - Positioning: Towson, MD 21204 Gluteus medius is a fan shaped muscle and the fibres join distally to form a tendon that inserts into the greater trochanter. The direct lateral approach to the hip for arthroplasty. Hip precautions can be a cause of discontent for the patients . Capsule. Incise the fascia lata over the femur and extend this incision proximally along the posterior border of the tensor fascia lata. Release the capsule sufficiently anteroinferiorly and anterosuperiorly to expose the femoral head and neck and permit free external rotation of the femur. Each hip replacement approach has its own specific restrictions. Environmental modifications that are recommended to prevent hip dislocations including removing tripping hazards from home and installing grab rails around the house. General guidelines (0-6 weeks) adhere to precautions Normalize gait pattern with appropriate aids based on WB'ing status ( time frame for using aids based on the discretion of therapist )on the discretion of therapist ) Hip ROM within restrictions Basic quadricep strength Total Hip Arthroplasty Exposure of the hip using a modified anterolateral approach. exclude forum, There are a variety of materials used to create the prosthetic components of an artificial hip. in forum only (options) Do not go more proximal than 5 cms because the superior gluteal artery and nerve which supplies the abductor muscles, runs across the incision here and can get damaged on deeper dissection. Risk of dislocation & hip precautions: Risk is incredibly low (<1%). Surgical landmarks are now considered- the iliac crest,anterior superior iliac spine. %PDF-1.5 - alcoholism: Posterior hip precautions generally include the avoidance of combined hip flexion, adduction, and internal rotation. In the Posterior Approach to Total Hip Replacement, the patient is placed side-lying and the operated hip capsule is cut posteriorly. Approach. endobj The anterolateral approach in total hip arthroplasty offers superb exposure that can be easily extended for complicated primary and revision surgery. This information is provided as an educational service and is not intended to serve as medical advice. Preliminary remarks. Abductor function after total hip replacement. Our Mantra: Hip precautions may needlessly increase patients anxieties and fear about dislocation following THR. - note that many patients will have a reduced hip flexion contracture under anesthesia, which will give the surgeon the false sense of having corrected the contracture; Hip Precautions - Anterior Approach Available from: Harkess JW, Crockarell JR. Arthroplasty of the hip. Some forms of DJD include osteoarthritis (OA), post-traumatic arthritis, rheumatoid arthritis (RA), avascular necrosis (AVN) and . Hardinge Approach to Hip Joint (Direct Lateral Approach) can easily be extended distally: To expose the shaft of the femur, split the vastus lateralis muscle in the direction of its fibers (. Comparison of heterotopic bone after anterolateral, transtrochanteric, and posterior approaches for total hip . Other features include a new section on post polio syndrome, additional case studies comparing Guillain Barr [], Courtesy: Zaid al Rub, Founder, OrthoPass. FInally did it- March of 2023now another question for all of you, Abductor wedge pillow - sleep tips request. % 1 0 obj Partial Hip Replacement. Do not go more than 3 cm above the upper border of the trochanter because more proximal dissection may damage branches of the superior gluteal nerve. A layered closure is preferred for periprosthetic fractures. Anterolateral approach. How To Choose A Surgeon For Hip Replacement, Speed Up Recovery After Total Hip Replacement, Can I Sit In A Recliner After Hip Replacement, Crossing Legs After Total Hip Surgery: (A PTs Complete Guide), Stairs After Total Hip Replacement: A Physical Therapy Guide, Ice After Total Knee Replacement: A PTs Complete Guide. Close the subcutaneous tissue and skin as desired. Hip precautions refer to certain things that one should not do after having total hip replacement (THR) surgery .Hip precautions are a common component of standard postoperative care following a THR.[1]  The precautions are prescribed for 6-12 weeks postoperatively to encourage healing and prevent hip dislocation. 8. A surgical incision, approximately 6 cm in size, is made to the anterolateral side of the thigh to gain access to the hip joint. Incise the fat and underlying deep fascia in line with the skin incision. Remember we are not going beyond 5 cms from tip of the greater trochanter to avoid damage to superior gluteal artery and nerve. The surgeon uses a special surgical table specifically designed to position the patient so that the hip joint may be easily accessed from the front as opposed to the side or back. The hip joint is then dislocated and the acetabular socket and femur are exposed for preparation and insertion of the prosthesis components. McFarland and Osborne technique. Dislocation Precautions: Dislocation precautions are based on surgical approach and the direction in which the hip is dislocated intra-operatively (if at all) to gain exposure to the joint. Telephone: 410.494.4994, Modified Hardinge Anterolateral Approach to the Hip, Partial anterior trochanteric osteotomy in total hip arthroplasty: Surgical technique and preliminary results of 127 cases, Acetabular Exposure and Preparation for Reaming. Jacqueline Donaldson, OT, PTA. Advantages and complications. The direct lateral approach to the hip for arthroplasty. Patients can also have as little as a 3-inch incision. Translateral surgical approach to the hip. Hamstring Curl Machine (hip precautions) 9. For example raised toilet seats and chairs to prevent bending at the hip more than 90 degrees, sock aids and dressing sticks for dressing and changing clothing easier, "easy reachers" to help them get items from the ground. mini-incision approach shows no longterm benefits to hip function extend to 10 cm below tip of greater trochanter Superficial dissection through subcutaneous fat incise fascia lata in lower half of incision extend proximally along anterior border of gluteus maximus split gluteus maximus muscle along avascular plane Hip dysplasia can present unique challenges in achieving stability with THA and, as such, there is a higher incidence of instability . Patients who have undergone this procedure are usually able to walk unassisted the day after surgery, and leave the hospital without the typical restrictions (such as crossing their legs) associated with total hip replacement. When sitting or standing from a chair, bed or toilet you must extend your operated leg in front of you. They understand the concept of not crossing their legs at the ankles but most of my patients do not know what dont cross your legs at the knee instructions mean. Do not step backwards with surgical leg. Physiotherapists and nurses in conjunction with surgeons usually teach these precautions to the patient in the perioperative period. The main landmark for the incision is the greater trochanter which overlies the hip joint itself. It can be protected by limiting proximal incision of gluteus medius muscle and putting a stay suture at the apex of gluteal split. The structures at risk duringhardinge approach to hip joint (direct lateral approach)include: Orthofixar does not endorse any treatments, procedures, products, or physicians referenced herein. The anterolateral approach/ the modified hardinge approach - commonly used for hemiarthroplasty in fracture neck of femur,total hip replacement. - consider the Hardinge approach for any patient who will have difficulty with complying with the usual hip precautions following surgery; Perform a meticulous debridement of all soft tissues before starting wound closure. 4 0 obj There are two small incisions made in this approach, one being the main access to the joint and through which nearly all the work is performed. Wheeless' Textbook of Orthopaedics. Insert suction drains if desired. Organize in-house training events for your surgical staff, Hand Distal phalanges revision published. This is because muscles/tendons are usually cut/detached during the operation and then repaired during closure. The modified-Hardinge approach, which preserves the posterior capsule, has been shown to have the lowest rate of dislocation, even in the absence of formal postoperative hip precautions.4,5 The posterior approach, which violates the posterior structures of the hip, has been historically associated with a higher rate of dislocation.6-10 Split the fibers of the vastus lateralis muscle overlying the lateral aspect of the base of the greater trochanter. Retract the cut edges of the fascia to pull the tensor fasciae latae anteriorly and the gluteus maximus posteriorly. Available from: I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. Fascia, Sterile dressing should be applied, and negative pressure incisional wound care can be considered. . Hip Dysplasia. 110 West Rd., Suite 227 Total hip arthroplasty: it has lower rate of total hip prosthetic dislocations. External rotation of the leg improves access to the hip capsule. There will be small variations in the approach from surgeon to surgeon, therefore most people will described there approach as a modified Hardinge approach. There are no muscles that are cut during this procedure but the front of the joint capsule must be cut in order to access the femoral head and socket. Distally, the anterior fibers of the vastus lateralis are elevated from the anterior femur. Surgical Exposures in Orthopaedics book 4th Edition, Campbels Operative Orthopaedics book 12th. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). The GJNH recommends patients follow hip precautions for 12 week post THA using both posterior and modified Hardinge anterolateral approach and irrespective of type of prosthesis. expose anterior joint capsule. - ensure that the sterile drapes are tied together underneath the operating room table (by the unscrubbed assistant) so that the drapes do not slide off the table as the leg is placed in the saddle bag; - Final Trial: Dr. Robert Donaldson, DC, PT. The trochanteric approach to the hip for prosthetic replacement. The fibers of the gluteus medius muscle are split in their own line distal to the point where the superior gluteal nerve supplies the muscle. Detach any fibers of the gluteus medius that attach to the deep surface of this fascia by sharp dissection. Expose the fascia lata sharply. PRECAUTIONS X 6 WEEKS Wear TED Hose Sleep on back Pillow under ankle, NOT under knee - keep foot of bed flat Pillow between legs while sleeping No active Abduction exercises No straight leg raise (SLR) No Flexion > 90 degrees No ER > 30 degrees No Extension > 30 degrees No Adduction past midline POST-OP WEEKS 1 - 6 Underneath this muscle is the hip capsule itself. The anterolateral approach (Watson-Jones) to the proximal femur, through the interval between glutei and tensor fasciae latae provides somewhat limited access to the hip joint along with the lateral proximal femur. Equipment exists for patients to make adherence to hip precautions easier. The layers being encountered are: The first 6 weeks are critical to maintaining these range of motion restrictions and these restrictions will remain precautionary for the rest of life. Scar tissue due to previous exposure might obscure typical landmarks. The proximal part of the incision is limited by the superior gluteal nerve and vessels, crossing 35 cm proximal to the tip of the greater trochanter. Abductor function after total hip replacement. Use retractors, to pull the edges of the fascia lata away so as to get a good view and access to the abductor muscles-the gluteus medius and minimus and the hip joint underneath that. Start the slightly anteriorly curved skin incision about 7-10 cm proximal of the lateral part of the greater trochanter (directed towards the tubercle of the iliac crest the posterior landmark of tensor fasciae latae origin). [1] The precautions are prescribed for 6-12 weeks postoperatively to encourage healing and prevent hip dislocation. As a healthcare provider, a senior citizen, and a patient that required three medications to control my high blood pressure, I started taking L-Arginine as a dietary supplement in 2006 and it has Mission Statement: The piriformis muscle and the short external rotators (tendons) are taken off the femur. - abductor function is better following bony reattachment of the anterior portions of these muscles. Retract the muscle inferiorly. He held credentials of Orthopedic Clinical Specialist in physical therapy for 20 years, QME in California, and taught at USC. 3 0 obj Exposure of the proximal femur is gained by gentle external rotation of the leg. The posterior (also referred to as a Moore or Southern) approach allows the surgeon to access the hip joint from the back. They require ligation or cautery. The Micro-Posterior Tissue Sparing approach aims to get patients back on their feet within days (possibly hours) instead of weeks. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. Data Trace Publishing Company The Hardinge approach was once the commonest approach for THR, but the issues with it are that it can damage the hip abductors, which can leave the patient with a persistent limp. Neither the anterior nor the posterior capsule is cut in this approach. DTIT]Hiv_~Zd #Ke0z3U?7-3KG|~LH22R9U I2JcAvaePNmgVhDcOb't^OaLK3mTj .!JR5\bdTg?`S>8y^|\Qm/Tt(Qm &+)YRJMj'9pGL4YakEXx Z}]2 5lFJA 1I*k@v35l`zg>}aUP=jv9-vfqXR4!KNax(vqz_ 8r Sc?^bUv=hrPe]F? Superficial dissection. After capsular closure, repair the vastus lateralis to its origin. No hip extension. Complementary and Alternative Medicine (CAM) for Postop Pain, prosthetic components of an artificial hip, minimally invasive surgery in hip replacement, Minimally invasive hip replacement approaches and procedures, Hip Resurfacing vs. This often requires the use of hip abduction pillows as well as avoidance of leg crossing and motions that result in hip flexion greater than 90. Abductor . Age In Place School is a division of Buena Physical Therapy Services, Inc.654 Creekmont CtVentura, CA 93003, link to Ice After Total Hip Replacement: A PTs Complete Guide, link to Lower Blood Pressure With A Simple Amino Acid: L-Arginine. Login to view comments. The abductor muscle "split". By Pil Whan Yoon 7 Videos. These same range-of-motions that are used to dislocate the hip at the surgery are the same range-of-motion movements that are restricted. Complications like posterior hip dislocation and infection were nil. An EMG and clinical review. For hip arthroplasty, retraction of the proximal femur distally will allow removing the femoral head fragment from the acetabulum. Additionally, the modified Hardinge approach was the most familiar approach for us and is widely used in the treatment of pediatric hip septic arthritis and femoral neck fracture [17]. This article will explain the correct way to use cold therapy options to reduce pain and swelling after a total hip replacement surgery. J')(o@ct9\ Preserve a substantial portion of gluteus medius insertion posteriorly. Required fields are marked *, This renowned classic provides unparalleled coverage of manual muscle testing, plus evaluation and treatment of faulty and painful postural conditions. . Hardinge Approach to Hip Joint (or Direct Lateral Approach)allows excellent exposure to the hip joint for joint replacement. The joint capsule seals the hip joint, much like a zip-lock baggie, to keep the lubricating fluids inside the capsule and bathing the hip joint in this fluid. Data Trace is the publisher of - note that if a Steinman pin as been used to retract the medius, it should be removed at this point, since it may placed signficant tension on the medius and give a false sense of hip stability; - Cautions: Outline an incision to release the anterior gluteus medius from the greater trochanter. The anterolateral (Watson Jones) approach involves the detachment of about one third of the gluteus medius from the bone. Your email address will not be published. Split the fibers of the gluteus medius muscle in the direction of their fibers beginning in the middle of the trochanter. - this approach allows a rather direct approach to the hip with minimal need for surgical assistants and affords excellent acetabular exposure; This is counterintuitive to the normal way to get up from a chair by leaning forward and pushing up with the legs.The legs will continue to supply most of the muscle power to stand from sitting, but the arms become important to keep the trunk erect coming from sitting to standing. Hardinge Approach to Hip Joint (Direct Lateral Approach) is used for: There is no true internervous plane for Hardinge approach to hip joint (direct lateral approach). Indications: Trauma - Hemiarthroplasty THR - lower dislocation rate Video: Positioning: Supine, GT at the edge of the table (buttock muscles, and . When descending, step first with the leg that you had surgery on. Over my career, I have seen several posterior approach total hip replacement dislocations, some as many as 20 years after surgery before they experienced their first dislocation. The anterior (Smith-Peterson) approach accesses the joint from the front. The direct lateral approach to the hip for arthroplasty. He owns and operates an orthopedic physical therapy practice. Skin, The anterior hip replacement procedure has fewer precautions. Direct lateral approach also called as the trans-gluteal approach initially described by Kocher in 1903 popularised by Hardinge in the modern age gives good exposure to the hip joint preserving most of gluteus medius minimus and vastus lateralis, and the vascularity. Fat, A hematoma requiring evacuation must be avoided. split fascia lata and retract anteriorly to expose tendon of gluteus medius. Make a longitudinal incision that passes over the center of the tip of the greater trochanter and extends down the line of the shaft of the femur for approximately 8 cm. A mid-lateral skin incision centered over the greater trochanter is made [Figure 3]. See my article on No Crossing The Legs.. Are Hip Precautions Necessary Post Total Hip Arthroplasty?. The greater trochanter is reattached later by wires or cables. Please consult a licensed physician and/or physical therapist in your area for specific medical advice about your condition. endobj Continue developing this anterior flap, following the contour of the bone onto the femoral neck, until the anterior hip joint capsule is fully exposed. This capsule will need to have time to heal before it can withstand the pressure from the femoral head as it rotates forward when the patient moves into the range-of-motion of external rotation and extension. The advantages of this approach include a significantly lower dislocation rate compared with other approaches while allowing for excellent acetabular visualization. https://www.tandfonline.com/doi/abs/10.1080/09638288.2020.1722262, http://www.sunnybrook.ca/content/?page=musckuloskeletal-hip-replacement-walking, https://www.youtube.com/watch?v=VfADxKAGdYM, https://www.youtube.com/watch?v=8OsN2J8HR6Q, https://www.youtube.com/watch?v=CUSSqFtolTU&app=desktop, https://www.physio-pedia.com/index.php?title=Hip_Precautions&oldid=324619. 2023 Lineage Medical, Inc. All rights reserved, Hip Direct Lateral Approach (Hardinge, Transgluteal), Approaches | Hip Direct Lateral Approach (Hardinge, Transgluteal), has lower rate of total hip prosthetic dislocations, begin 5cm proximal to tip of greater trochanter, longitudinal incision centered over tip of greater trochanter and extends down the line of the femur about 8cm, detach fibers of gluteus medius that attach to fascia lata using sharp dissection, split fibers of gluteus mediuslongitudinally starting at middle of greater trochanter, do not extend more than 3-5 cm above greater trochanter to prevent injury to, extend incison inferior through the fibers of, anterior aspect of gluteus medius from anterior greater trochanter with its underlying gluteus minimus, requires sharp dissection of muscles off bone or lifting small fleck of bone, follow dissection anteriorly along greater trochanter and onto femoral neck which leads to capsule, gluteus minimus needs to be released from anterior greater trochanter, runs between gluteus medius and minimus 3-5 cm above greater trochanter, limiting proximal incision of gluteus medius, most lateral structure in neurovascular bundle of anterior thigh, keep retractors on bone with no soft tissue under to prevent iatrogenic injury, - Hip Direct Lateral Approach (Hardinge, Transgluteal), Shoulder Anterior (Deltopectoral) Approach, Shoulder Lateral (Deltoid Splitting) Approach, Shoulder Arthroscopy: Indications & Approach, Anterior (Brachialis Splitting) Approach to Humerus, Posterior Approach to the Acetabulum (Kocher-Langenbeck), Extensile (extended iliofemoral) Approach to Acetabulum, Hip Anterolateral Approach (Watson-Jones), Hip Posterior Approach (Moore or Southern), Anteromedial Approach to Medial Malleolus and Ankle, Posteromedial Approach to Medial Malleolus, Gatellier Posterolateral Approach to Ankle, Tarsus and Ankle Kocher (Lateral) Approach, Ollier's Lateral Approach to the Hindfoot, Medial approach to MTP joint of great toe, Dorsomedial Approach to MTP Joint of Great Toe, Posterior Approach to Thoracolumbar Spine, Retroperitoneal (Anterolateral) Approach to the Lumbar Spine.
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