hip•opsurg-revision-thr

Revision Total Hip Joint Replacement

intermediate Level

Primary Indication

Painful, aseptic loosening of one or both components; Progressive bone loss (with or without pain); Fracture or mechanical failure of implant; Recurrent or irreducible dislocation; Infected THR as one or two stage procedure; Treatment of periprosthetic fracture

Danger Structures

Sciatic nerve - 15-30mm posterior to hip joint depending on approach and position, injury causes foot drop and sensory loss - EXAM KEY: identify and protect, keep hip flexed to relax nerve
Femoral neurovascular bundle - 30-50mm medial to anterior hip joint, injury catastrophic - EXAM KEY: stay on bone with anterior retractors
Superior gluteal neurovascular bundle - 30-50mm proximal to greater trochanter, injury causes abductor weakness - EXAM KEY: avoid proximal dissection, stay in safe zone
Lateral femoral cutaneous nerve - variable position 20-50mm from anterior incisions, injury causes meralgia paresthetica - EXAM KEY: protect when visible
Medial femoral circumflex artery - main blood supply to femoral head, at risk during capsulotomy - EXAM KEY: careful dissection around posterior femoral neck

Visual Atlas

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