THE USE OF LATERAL ACCESS TO THE HIP JOINT FOR ENDOPROSTHETICS

The aim of the study is the development of lateral access to the hip joint when performing endoprosthetics in patients with 3rd stage protrusion coxarthrosis Materials and Methods. Endoprosthetics of the hip was performed in 44 patients with 3rd stage protrusion coxarthrosis, complicated by signification ossification of the edges of the acetabulum and its lip. Mean patient age – 60±1.5 years old Women comprised 63.6% Surgical approach to the hip according to the Hardinge method ( K. Hardinge ) was used in 29 patients; 15 patients were operated using the modified lateral access. comparison analysis of the use of lateral access for endoprosthetics was conducted. It access Hardinge is a of muscles, which the operated extremity and be the factor for complications. The of access a negative on the recovery of the function of the operated hip. the modified lateral access, universal guide marks were used in the projection of the greater trochanter, which allow for the most precise initial points of the performed incisions to be and the ligament-muscular sheet of the gluteus medius muscle to be formed correctly. a central line and the of the proximal, and distal parts of the greater trochanter it possible to precisely perform three incisions on the gluteus medius muscle. It was that, by the 7th day after the surgery, a significant difference in the function of the operated hip which was with access as per Hardinge than with the of modified lateral access. condition of the operated hip, and decreases the risk of infectious complications. analysis of the obtained data between the groups was performed with the non-parametric Mann-Whitney test. The differences were significant at p < 0.05.

Hardinge approach and the proposed modified lateral access. In all patients, HJR was performed with an ESI endoprosthesis.
A direct lateral access proposed by Bauer and modified by Hardinge includes a 12-16 cm skin dissection anterior to the greater trochanter, dissection of the broad fascia along the operative wound, separation of the fibers of the gluteus medius muscle along 3 cm anterior to the greater trochanter, subperiosteal separation of the gluteus medius muscle and the lateral portion of the quadriceps muscle of the thigh from the anterior surface of the greater trochanter. Further, a dislocation of the femoral head is performed followed by the other surgical manipulations [3,4].
The modified lateral approach to the hip joint includes the following stages: skin dissection in the projection of the greater trochanter, dissection of the broad fascia, and the performance of three incisions. The first 3-cm-long incision is made from the proximal point along the fibers of the gluteus medius muscle in the anterosuperior direction. The second 3-cm-long incision is made anteriorly from the point on the borderline between the median and distal third of the greater trochanter 1 cm from the central line. The third incision is made by a bow-like connection (convex anteriorly) of the initial points of the first and second incisions ( Figure 1). The gluteus medius muscle is dissected from the anterior surface of the greater trochanter within the performed incisions. The obtained flap of the gluteus medius muscle is moved anteriorly and fixed with surgical instruments. Further, a dislocation of the femoral head and hip joint replacement are performed. After the main step, the anteriorly moved muscular-tendon flap is placed back and fixed with sutures [5]. Statistical processing of the obtained results was performed with the Statistica 8.0 software.
The comparative analysis of the obtained data between the groups was performed with the nonparametric Mann-Whitney test. The differences were significant at p < 0.05.
The present study was approved by the local ethical committee. The aim and methods were explained to the participants who signed the form of the informed consent for the examination, treatment, and publication of the obtained data.
RESULTS. The Hardinge approach during HJR was used for 29 patients with 3rd-degree protrusion coxarthrosis (Group I). The modified lateral approach was used in 15 patients with 3rddegree protrusion coxarthrosis (Group II).
The evaluation of the results of the application of these surgical approaches to the hip joint included intraoperative and postoperative hemorrhage, intraoperative visualization of the hip joint, intraoperative muscle strain and rupture, and functional results by the Harris scale [6].
The analysis of the obtained results showed that intraoperative visualization was sufficient in both groups. No strains and ruptures were registered during the stages of HJR.
The analysis of blood loss revealed that in patients from Group I (Hardinge approach), the volume of intraoperative and postoperative hemorrhage was significantly higher than in patients from Group II (Table 1). In patients from Group II with the modified lateral approach to the hip joint, the wound was The modified lateral access to the hip joint during HJR appears to be less traumatic due to the formation of a mobile myotendinous flap from the gluteus medius. This approach is also more physiological, prevents strains and rupture of muscular fibers, increases the area of visualization of the operative field and surgical manipulations during HJR, contributes to faster regeneration of the surrounding muscular tissue and the functional status of the operated hip joint, and reduces the risk of infectious complications.

CONCLUSIONS.
A comparative analysis of the lateral approaches to the hip joint during HJR allowed the authors to reveal their drawbacks. The Muller access leads to overextension, strain, and rupture of the gluteus medius muscle, which negatively influences the joint functioning and increases the risk of infectious complications. The Hardinge approach is more traumatic because of the damage of more muscles during the surgery, which slows down the process of restoration of functioning of the operated limb and can cause infectious complications.
The modified lateral approach to the hip allows the surgeons to avoid the drawbacks of the Muller and Hardinge approaches dues to the formation of a mobile myotendinous flap from the gluteus medius muscle.

FINANCIAL SUPPORT AND SPONSORSHIP
Nil.