the hip, knee and shoulder — all the while keeping patients safe.
Hips
There's some debate over whether the anterior or posterior approach is
best for total hips, but there's no doubt patient positioning is critically
important for both.
• Posterior. Patients are positioned on their sides in the lateral decubi-
tus position. Pegboards — a flat surface roughly the size of an OR table
with dozens of tiny peg holes spread throughout — are simple devices that
attach directly to a standard OR table and offer surgeons the ability to
position and stabilize a variety of different-sized patients in the lateral posi-
tion.
After patients are anesthetized, they're rolled onto their sides and the
pegs are strategically placed to ensure stability and proper positioning. For
example, anterior pegs are placed near the pubic region and directly below
the pectoral muscle. Posterior pegs go near the scapula, as well as in the
lumbar and sacral areas. Padding is used to cover the area where the
patient lays.
"The leg profile pegs let me move the hip in a variety of different posi-
tions during the surgery, so I can make sure it's still stable inside the sock-
et," says Mitchell C. Weiser, MD, the fellowship director of adult recon-
struction at Montefiore Health System in Bronx, N.Y.
When placing patients in the lateral position, pay close attention to how
much stress you place on the sciatic nerve and avoid flexing the hip. The
lateral position also compresses the axillary nerve. Placing an axillary roll
beneath the patient's ribs relieves pressure near the nerve, says Dr. Weiser.
He also says skin pressure ulcers can occur around the greater trochanter
and the head of the fibula, and suggests applying plenty of padding in
those areas.
• Anterior. With patients in the supine position, be aware of the pressure
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