433 - Supine Anterior Total Hip Replacement

table with femur lift is crucial for positioning and expo- sure. Microplasty retractors also aid in providing good exposure of the hip components. For the purpose of this article, the anterior supine intramuscular total hip arthro- plasty surgical technique in conjunction with the fracture table will be referenced. P O S I T I O N I N G After the timeout is performed, the patient is placed under general anesthesia. The patient is in the supine position on the fracture table with both feet placed in the appropri- ately sized boots and attached to the bed. The groin post is placed in position with proper padding in contact areas. The arms are both placed extended on arm boards less than 90 degrees. The removable leg pad board is taken off the bed. The patient is now in the supine position with their legs suspended in neutral position and all pressure points are again checked to ensure patient safety. P R E P P I N G A N D D R A P I N G After positioning and prior to prepping the patient, the surgical area is draped with a clear U-split drape and a clear bar towel drape from the apex of the pubic crest to the above the knee, then precleaned with 70 percent iso- propyl alcohol and allowed to dry. The circulating nurse uses chlorhexidine gluconate to prep the surgical area inside the U-drape and clear bar towel drape. After the three-minute drying time, the sterile drapes are placed. First, a top drape or a bar drape is used from the knee to the foot. On top of the top drape, two imper vious blue U-split drapes are placed to isolate the sur- gical site. Next, chlorhexidine gluconate is applied again to the surgical site. The next layer is made up of two top split drapes. The incision is marked with a surgical marker running on top of the greater trochanter from two finger widths below and two finger widths lateral to the anterior superior iliac spine (ASIS). The surgeon will stay lateral to the tensor-sartorius interval to avoid the lateral femoral cutaneous nerve, which is approximately 30 degrees away from the midline of the ASIS. The antimicrobial incise drape is placed over any skin that is exposed. A V-pouch drape is placed on the split drape posterior to the incision to catch any blood or fluid that might come from the wound. An ESU Bovie pencil, suction, pulse lavage suction irrigator, and a tissue sealer coagulator are used on the field and the circulator connects the unsterile end to the generator. The fracture table and femur lift are placed on the bed. The bar is impacted onto the lift and the pedal is pressed to ensure that the femur lift is working. P R O C E D U R E An incision is made approximately one centimeter lateral and distal to the anterior superior iliac crest and extended distally and laterally over the tensor fascia muscle belly, with a 10 blade on a #3 handle. Bleeding is controlled through use of electrocautery. The surgeon begins dissecting down through the layers and places a deep Gelpi retractor in the wound for better visualization. A Cobb elevator is used to dissect the fat tissue from the fascia. A 15 blade on a #3 handle is used to make an incision the length of the skin in the fascia. On the anterior edge of the fascial incision, two Allis clamps are placed and the muscle layer is dis- sected from the fascia with a Cobb elevator. The two Allis clamps are removed and placed on the posterior edge, and the same dissection occurs. The Allis clamps are removed, and the muscle is separated bluntly. The tensor fascia lata (TFL) is mobilized laterally and the deep Gelpi retractor is repositioned along with a #7 Hohmann retractor to visual- ize the floor of the TFL fascia. Dissection continues through the floor of the TFL until the capsule is palpated and cir- cumflex arteries are controlled with the ESU Bovie. A #6 Hohmann is inserted under the rectus femoris. Pericapsular fat is debrided and the head of the rectus femoris is released to aid in the exposure of the femoral neck. An inverted T capsulotomy is performed anteriorly and superiorly with the There are many products on the market that make the anterior approach total hip replacement a faster and eas- ier procedure. A fracture table with femur lift is crucial for positioning and exposure. | The Surgical Technologist | JANUARY 2020 12