Modified Stracathro Approach To The Hip For Arthroplasty: Results In 31 Patients

Abstract

The choice of surgical approach to the hip is based on the preference and training of the attending surgeon as well as safety. The stracathro lateral approach has a high safety profile and a low rate of hip dislocation. However, this lateral approach is limited by the restriction to proximal dissection at about 5cm above the greater trochanter (GT) by the superior gluteal nerve, the risk of increased bleeding from osteotomized bone and increased incidence of heterotopic calcification. During hip surgery when there is soft tissue contracture around the hip, the limitations of the lateral approach become quite glaring. Extensive soft tissue contractures and severe disuse osteoporosis commonly complicate cervical fractures of the femur in sub-Saharan Africa where traditional healers dabble into its treatment. We modified the stracathro approach to suit patients presenting with soft-tissue contracture and disuse osteoporosis after ineffectual treatment by traditional bonesetters. The modification entailed sharp extensive subperiosteal reflection of the anterior and posterior halves of the musculo-tendinous unit (the conjoint tendon) of the gluteus medius and vastus lateralis off the greater trochanter without osteotomy. We have used this approach for total and hemi-arthroplasty of the hip with satisfactory outcome. The results in 31 patients are hereby presented.