terior approach, direct lateral approach or direct anterior approach.
The anterior approach requires placing the patient in the supine posi-
tion with the leg on the side of the operative hip hyperextended to
just off the floor. Operating at the front of the hip is a muscle-sparing
technique that results in shorter recoveries, but is technically demand-
ing for surgeons to perform. The lateral approach can be performed
with the patient in the lateral decubitus position or supine position.
The posterior approach is performed with the patient in the lateral
decubitus position. Ms. Prevatt suggests protecting the following
areas when placing patients laterally:
• Face, ear and head. Align the head with the spine. Ensure the ear
is not folded over because this could cause tissue ischemia and lead
to skin breakdown. Blankets and pillows can be used to build up a
surface for alignment, however an air-filled pressure redistributing
pad or fluidized positioner pillow on top of the pile will provide more
pressure-relief than foam, traditional pillows or blankets.
• Dependent shoulder. Support the shoulder with a soft axillary roll
just distal to the axilla. This allows for better blood flow to the lower
extremities and prevents nerve injuries to the arm and hand. The axil-
lary roll should not be made by rolling up a blanket or towel because
these surfaces have very little pressure redistributing qualities and
would apply significant pressure to skin over the thoracic area.
• Dependent arm. Secure the arm on an armboard and make sure
it's abducted at no more than a 90-degree angle. Pad the elbow.
• Dependent hip. Apply a silicone foam dressing to prevent skin
tearing from shear forces. Also place an air-filled pressure redistribut-
ing pad under the trochanter to reduce pressure on the bony surface.
• Dependent leg. An air-filled pressure redistributing pad can be used
under the lateral knee and ankle. Pillows may be used under and
between the knees, but keep in mind that pillows and foam compress
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