Surgical Procedure Summary

Direct Anterior Hip Replacement with FLOTE

This is probably the definitive movie on the technique, from Drs Thornhill, Ready and Brick - professors at Harvard Medical School:

http://mdvideocenter.brighamandwomens.org/specialties/orthopedic-and-arthritis/direct-anterior-approach-for-total-hip-arthroplasty

This is a brief summary of the stages we use in DAA with FLOTE.  It is not intended to describe or instruct on how to carry out a complex surgical technique and is certainly no sustitute for a surgeon's depth of experience on the subject.

We seek only to highlight what FLOTE allows - not the surgical detail which is determined by the surgeon. 

For more movies, white papers, etc, please click here

  1. Remove all extension plates/panels from the operating table
  2. Install our 'table interface' and clamp to the accessory side rails of the operating table (see IFU's for full details)
  3. If desired, the whole assembly can then be moved into the anaesthetic area
  4. Load the patient and secure the legs with the safety straps
  5. Administer anaesthetic
  6. Fit inflatable boot onto the foot of the leg to be operated on. (consider barrier gauze or sock at this point)
  7. If relevant, when ready, return the table assembly with patient into the operating theatre
  8. When the patient, anaesthetic team, surgical team et al are ready - wheel FLOTE between the patient's legs until it locks the perineum post into the table interface.
  9. Adjust the patient position - perinuem up against the perineum post (which may have been covered with barrier gauze)
  10. With the traction carrier free to slide, engage the hook on the sole of the boot into the receptacle on the traction carrier.
  11. Lock the traction carrier with the patient's leg extended straight.
  12. Disengage the lock on the leg support for the leg to operated on and retract that leg support.
  13. If required, lower the leg support flap.
  14. The patient and FLOTE are now ready for the surgical team to complete the patient preparation for surgery.
  15. The controls for leg manipulation are all at the distal end of the device so they can be operated from outside the sterile, draped area.
  16. When the surgeon is ready to make the first incision, the first step us usually to raise the foot a little and internally rotate the foot ~10-20 degrees, with a little adduction, according to the surgeon's judgement
  17. When the surgeon is ready to sever the femur ~20-30mm of traction is applied by rotating the traction handle (~4-6 turns).  External rotation of ~45 degrees may give a better view of the target cutting position.
  18. X-ray imaging may now be used to ensure that the femur is cut at the desired place. (Note to radiographer; the vertical on FLOTE can be used a visual refence guide for alignment of the C-arm imaging device)
  19. Once the femur is severed the surgeon may require minor adjustments to allow access for removal of the femoral head and preparation of the acetabulum, etc.  Often facilitated by unlocking the foot rotation.  Again, x-ray imaging may be used to facilitate reamer positioning, depth, etc. and alignment and positioning of the cup.
  20. Having completed the final cup insertion, the foot is externally rotated and the beam gently lowered to the floor and locked, with a degree of adduction to allow optimal exposure of the proximal femur.
  21. The surgeon may now proceed to preparing the femur for stem insertion.  Again, x-ray imaging can be used to ensure that all instruments are going down the centre of the femoral canal.  Foot rotation can be useful here.
  22. If trial reduction is indicated, it is possible to fully image all the stages during the reduction.
  23. Joint reduction requires a little synchronisation - the FLOTE beam is unlocked and then in a smooth action, the adduction is removed, the external rotation of the foot is released (possibly with the assistance of the knee being rotated in sympathy) as the foot is raised back to level while the surgeon guide the head into the socket.  A little extra traction may be applied to allow the head to fully engage if it hasn't already.
  24. Comparable imaging of both sides/joints can be carried out to ensure correct alignment, offset, leg length, etc.
  25. The surgeon may now carry out a full 'flex and stability' check by lifting the knee towards him (the foot is safe and stable on the sliding track) and rotating the knee outwards and back.
  26. If this was a trial reduction, steps 20-25 can now be repeated with the final implants.
  27. The patient can now be closed and otherwise dealt with in the normal way.
  28. Once the patient is undraped and ready for removal, restore the leg support to its starting position and disengage the boot from the locked clip on the perineum pad.
  29. With both legs secured with straps, FLOTE can now be removed, by unlocking the security pin in the pereneum pin, and wheeled out of the way.
  30. The patient can now be dealt with as normal.