Step 1.

Taking the posterolateral approach of the hip joint as an example, the incision was firstly made to determine the vertex of the greater trochanter. 1/3 incision was made at the proximal end of the vertex of the greater trochanter, 2/3 incision was made at the distal end of the greater trochanter, and a slightly oblique incision was made along the posterior edge of the greater trochanter, with a general length of 14-16cm.

 

Step 2.

Incise the skin, subcutaneous fat and tensor fascia lata, obtuse separate gluteus maximus muscle fibers, use medium muscle to pull two opposite retraction gluteus maximus muscle, expose the external rotation muscle group behind the great trochanter and the fat tissue on its surface and the posterior margin of gluteus medius muscle, obtuse dissection.

 

Step 3.

Extend the lower extremity and turn inward to expose the external rotator cuff at the insertion behind the greater tuberosity, do you cut off the insertion of the external rotator cuff, the piriformis, the superior gemellus, the obturator internus, the inferior gemellus (or, if necessary, the quadratus femoris).

 

Step 4.

Bluntness classifies the adipose tissue outside the capsule, exposes the capsule, and makes an incision between the acetabular margin and the trochanter of the femur.

 

Step 5.

Hip flexion, adduction, internal rotation, so that the center of the foot up, generally dislocation of the joint. The osteotomy plane can be determined by osteotomy plate or medullary cavity file. The length of the femoral calcaneus should be based on the preoperative design, and the average femoral calcaneus 1-5cm vertical femoral neck osteotomy should be retained above the small trochanter.

 

Step 6.

The femoral neck osteotomy must be perpendicular to the coronal plane of the femoral neck and should be consistent with the direction of the prosthetic collar.

 

Step 7.

Extend the lower extremities and rotate inside, using the acetabular retractor to fully expose the acetabular area. Remove osteophytes and capsule around the acetabulum and soft tissue inside the acetabulum, and protect the transverse acetabular ligament.

 

Step 8.

The acetabular cartilage is ground with a acetabular file, which is reduced to a large file until the subchondral bone of the acetabulum is exposed. That is to say, there is even punctate bleeding at the interface.

 

Step 9.

The specification of the acetabular prosthesis is confirmed by the external cup test. Generally, the external diameter of the selected prosthesis (the same as the test) is 2mm larger than the final specification of the acetabular file.

 

Step 10.

Open the metal outer cup of the acetabular prosthesis and connect the corresponding metal outer cup implant bracket and implant rod.

 

Step 11.

Connect the acetabular implant locator to the metal cup implant rod. Pay attention to the position of acetabular notch. Rhythmically hammer the acetabular prosthesis into the rod. Do not use violence until the acetabular prosthesis is completely anastomosed with the osseous acetabulum. Pay attention to the valgus (55 degrees) and anteversion (15 degrees) of the acetabular prosthesis.

 

Step 12.

Unscrew the metal outer cup and implanted stem, remove the metal outer cup plant kindergarten, according to the stability of the prosthesis implantation after condition to decide whether to use acetabulum screw, using acetabulum screws, first the acetabulum screw seal nut off, through all the wizard drill with universal bit by the acetabulum screw hole drilling, reconfirm by depth gauge length of the acetabulum screws used, screwing in the acetabulum with a screwdriver universal socket head screws.

 

Step 13.
Insert the corresponding inner cup trial mold, confirm the position of the acetabular notch through the relationship between the inner cup positioning column on the metal outer cup edge and the positioning groove on the inner cup edge, and then insert the inner cup trial mold after confirming the position of the prosthesis.

 

Step 14.
Both hip and knee joints are flexed by 90 °, with internal rotation and adduction of the hip joint. The assistant supports the knee joint and chooses to use an opener or Emei chisel to open along the direction of the femoral bone marrow cavity at the intertrochanteric fossa, with a depth of about 1-1.5cm.

 

Step 15.
Choose to use a soft drill and drill along the femoral medullary cavity, paying attention to the depth of penetration (150mm downwards from the midpoint of the proximal femoral osteotomy surface). The use of a soft drill should be small to large until there is slight contact between the soft drill and the cortex of the femoral medullary cavity, which can confirm the distal diameter of the femoral prosthesis.

 

Step 16.
Select the appropriate size of the medullary cavity file based on the preoperative X-ray template and intraoperative measurements, connect the stem of the medullary cavity file, and rhythmically insert it along the femoral medullary cavity until it is 2mm below the proximal femoral osteotomy surface.

 

Step 17.
Remove the handle of the medullary cavity file from the file and insert a flat headed file into the neck of the file to level the proximal femoral osteotomy surface. The proximal femoral osteotomy surface must be leveled.

 

Step 18.
Install the neck collar test mold and metal test mold head. The test collar should be in full contact with the bone cutting surface, and the test head should be installed in place. The 49.5mm metal test mold head is the standard head.

 

Step 19.
Reset the hip joint and check if the position between the femoral prosthesis and the acetabular prosthesis is correct. Generally, it is appropriate to achieve maximum coverage of the head and acetabulum in a neutral position of the hip joint.

 

Step 20.
After installing the TOP inner cup, select a femoral prosthesis with the same specifications as the medullary cavity file, connect the impactor, and implant the prosthesis rhythmically.

 

Step 21.
If necessary, remove the movable collar of the prosthesis, use a bone grafting spoon and rod to graft bone into the groove of the prosthesis, and then fix the collar again. When fixing the collar, rotate counterclockwise to tighten it.

 

Step 22.
Insert a hammer into the neck of the femoral prosthesis with a handle until the collar of the prosthesis is completely aligned with the proximal femoral osteotomy surface.

 

Step 23.
Drill holes through the protrusion of the greater trochanter of the prosthesis using a drill bit until it penetrates the femoral cortex, and confirm the length of the greater trochanter screw using a depth gauge.

 

Step 24.
Use an Allen screwdriver to tighten the large rotor screws.

 

Step 25.
Install the plastic test head on the prosthesis, reset the hip joint, recheck the position of the prosthesis and the tightness of the joint, and confirm the head and neck length of the prosthesis used.

 

Step 26.
Wipe the neck of the prosthetic stem clean and install the prosthetic head.

 

Step 27.
Use a tap to lightly tap 1-2 times.

 

Step 28.
Reset the joint, rinse the wound, place drainage, intermittently suture the incision layer by layer, and the surgery ends.