that's applied on both the sciatic and femoral nerves. Positioning patients
to give surgeons clear access is particularly critical during this approach,
as hip instruments are moving around the femoral artery.
Consider investing in a specialized traction table that lets surgeons per-
form a single-incision total hip procedure from the front of the joint — as
opposed to the side or back — without detaching muscle from the pelvis
or femur.
Michael Bates, MD, an orthopedic surgeon with OrthoCarolina
University in Charlotte, N.C., uses a traction table that lets him position
patients for total hips without the help of an assistant. The table's traction
device positions patients so their legs can move independently of one
another. It also features a femoral lift system that secures the hip and gives
him access to the femur.
"It's a 6-figure investment, but well worth it for the positioning consisten-
cy it provides," says Dr. Bates. "I can use the table to put the leg at 60
degrees of external rotation and do 2 turns of traction. I can't get that type
of precision when working with an assistant. All I can say is 'pull harder'
or 'pull less hard.'"
Patient size can be a factor in giving surgeons the access they need to
the hip joint. "With larger patients, the abdominal pannus can fall over the
thigh and obstruct your view," says Michael Archdeacon, MD, the medical
director of operative services at the University of Cincinnati Medical
Center in Ohio. He proposes a simple fix: Use about 8 strips of 4-inch tape
to pull the fold out of the surgical field and secure it to a large surface
area.
Knees
Total knee patients are generally placed in the supine position, their knees
flexed at about 90 degrees with a maximum amount of flexibility.
Dr. Bates relies on a lateral post and foot bump positioner to perfect
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