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Direct superior portal-assisted THA suited for same-day surgery

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Brad L. Penenberg

KOLOA, Hawaii — As piriformis and conjoined tendon releases are not required with the direct super portal-assisted approach and it preserves the iliotibial band, patients who undergo total hip arthroplasty with this approach have excellent early function and reduced pain postoperatively, according to a speaker at Orthopedics Today Hawaii, here.

Brad L. Penenberg, MD, discussed the rationale for direct superior portal-assisted THA. The interval he uses during this surgery is posterior to the proximal iliotibial band and the inline femoral access it allows mitigates the use of a special table in the OR.

“We do not use offset instrumentation. We use inline broaching. It gives direct access without contorting the leg,” Penenberg said when he described the femoral side of the procedure.

“On the acetabular side, the difference between this direct superior and one of the other alternatives is that we do not need offset instrumentation. We do not need offset cup holders and alignment guides, which could be misleading. We use a portal and a cannula, which allows complete visualization of the acetabulum [and] preservation of the iliotibial band,” he said.

Penenberg noted 75% of the gluteus maximus — the largest muscle in the body — extends and attaches to the posterior aspect of the iliotibial band and contributes to stabilization of the pelvis. Preservation of the iliotibial band, therefore, is among the key advantages of the technique and why it has fewer risks, he said.

“When we cut the tendon of a significant muscle group, there is going to be compromise. There will be pain. There will be limp. If we can conserve that muscle tendon group, then perhaps we can take advantage of this guidewire effect of the iliotibial band” as a pelvis stabilizer, Penenberg said, noting this strategy is part of the anatomic rationale for the fast recovery patients experience following THA performed with the direct superior portal-assisted approach.

“It is a perfect option for the ASC or the same-day option,” he said. – by Susan M. Rapp

Reference:

Penenberg BL. Direct superior portal assisted. Presented at: Orthopedics Today Hawaii; Jan. 12-16, 2020; Koloa, Hawaii.

Disclosure: Penenberg reports he receives royalties from Microport Orthopedics; receives royalties from and is a consultant for Zimmer Biomet; and is a stockholder and board member for Radlink.