Sutures: 

  1. #1 Vicryl   x3
  2. #2 Stratafix Spiral PDO x 1
  3. #2-0  Vicryl   x 2
  4. #3-0Vicryl  x 1
  5. Staples for skin
  6. #2 PDS for MAKO Acetabular and femoral Mako check point screws

Injection:

  1. Marcaine 100mg ( 0.5% Marcaine 20ml or 0.25% Marcaine 40 ml)
  2. Toradol 30 mg (15 mg if over 70 years old or poor renal function)
  3. Morphine with epinephrine 4mg
  4. Add Saline and mix up to 60 ml  ( total 60 ml liquid for injection ) 
  5. 16 gauge needle, cut off needle protector (CHECK Allergy for medications)

Drain:

                1/8” Hemovac drain x1

Common Instruments or requirments:

 

  1. Methylene Blue (If Mako THA)
  2. Ortho Impactors
  3. Manual leg length measurement set
  4. Charnley pin
  5. Grasper x1
  6. Ronguer x3
  7. Hibbs Retractor x2
  8. Rake retractor x2
  9. Osteotome: straight and Curved – 1/8, ¼ , 3/8”
  10. Standard and Long Bovie
  11. Long handle Blade

Positioning: 

      Supine Position

  1. 3 EKG Leads and 2 Tegaderms
  2. Check the leg length

       Lateral position

  1. Hip Grip II positioner
  2. Accessory Roll
  3. “U” Drape

Procedure: 

  1. Retractors: (see attached picture)
    1. 1, 2, 3 and 4: Hohmann Acetabular Retractor
    2. 5 and 6: Curved  Blade Bent Hohmann retractor (use for Posterior Acetabular and femoral neck)
    3. 7: Double Bent Bend Hohmann Retractor (Anterior acetabular)
    4. 8L and 9R: Posterior Capsule and sciatic Nerve Protection retractor (L for left and R for right)
    5. Femoral Neck Elevates ( Long Handle)
  1. Pelvic Array Placement
    1. Three Pin Pelvic Clamp, 3 short Threaded pins (Long ping for super  thicker subcutaneous tissue)
    2. Methylene Blue, #15 Blade
    3. Drill, Screw Driver
    4. Pelvic Arrow
  1. Incision (Posterior hip approach)
    1. Posterior hip approach w/ #20 Blade
    2. Fascia and muscle incises w/Bovie
    3. Suction to the assistant
    4. Flex knee and internal rotate hip
    5. No 3 Retractor for greater trochanter muscle
    6. Pick-ups and Bovie to incise the capsule into joint
    7. Periosteal elevator
    8. 6 Retractor for femoral neck
    9. Insert Charnley pin with Mallet
    10. Insert Acetabular check point screw, W/screw Driver and Mallet
    11. Insert femoral check point screw , W/screw Driver and Mallet
    12. Insert Pin at above acetabulum for manual measurement, blade and mallet
    13. Place the legs at same position
    14. USE Leg Length Measure to check preop Leg Length and offset. Do not dissemble The Measure tool
    15. Place Pelvic Array
    16. Use Probe to tough femoral check point and anterior patellar EKG lead
    17. Dislocate hip
    18. Place No. 2 and 6 retractors at superior and inferior neck.
    19. Paper ruler to measure the neck cut
    20. Oscillating Saw Blade to cut femoral neck
    21. 3/8” osteorome and Mallet if appicable
    22. Remove the femoral head
    23. Measure the size of the head.
  1. Femoral preparation
    1. Periosteal elevator for femoral neck
    2. Place No. 3 retractor at Greater Trochanter, Femoral neck retractor to Femoral neck and No. 6 to Neck corner
    3. Hip at maximum internal rotation and abduction
    4. Pick-ups and Bovie to remove soft tissue
    5. Optional Large ronguer (if applicable)
    6. removal of the lateral cortical bone W/ Modular Box Osteotome and mallet
    7. The Axial Starter Reamer W/ T-Handle
    8. Lateralized reamer with power
    9. Broaching from size 0 to Max with Broach handle and Mallet
    10. Remove broach
    11. Remove the retractors.
  1. Acetabular Preparation
    1. 3 retractor at anterior acetabulum,
    2. No 7 retractor / W Mallet. Remove No. 2 retractor
    3. Optional: Long handle Blade
    4. 6 retractor at posterior acetabulum W/ Mallet
    5. No 4 retractor inferior to transversal ligament
    6. Bovie with long tip with Grasper
    7. Long handle Blade
    8. Clean the acetabulum
  1. Acetabular Registration, Reaming and impacting cup
    1. Probe to touch acetabular check point twice
    2. Register acetabular bone following computer monitor
    3. Single reamer W/ Mako Robot
    4. Acetabular trial  W/ Mallet
    5. Place slurring bone into acetabulum
    6. Insert Metal shell w/ MAKO Robot W/ Mallet
    7. Cup Plane W/ probe
    8. Impact final acetabular liner into metal shell.
  1. Trial
    1. Place No. 3 retractor at Greater Trochanter, Femoral neck retractor to Femoral neck and No. 6 to Neck corner
    2. Hip at internal rotation and abduction
    3. Insert the broacher W/ Mallet
    4. Impact Neck and femoral head trial
    5. Reduce the hip with traction, external rotation and extension W/ Kocher and impactor
    6. Place the legs at same position
    7. Use Probe to tough femoral check point and anterior patellar EKG lead
    8. USE Leg Length Measure to check preop Leg Length and offset. Do not dissemble The Measure tool
    9. Dislocation, remove neck and head, remove Broacher W/ Mallet
    10. Place No. 3 retractor at Greater Trochanter, Femoral neck retractor to Femoral neck and No. 6 to Neck corner
    11. Hip at internal rotation and abduction
    12. Impacted Final stem W/Mallet
    13. Impact final head W/ impactor and Mallet
    14. Reduce the hip
    15. Place the legs at same position
    16. Use Probe to tough femoral check point and anterior patellar EKG lead
    17. USE Leg Length Measure to check preop Leg Length and offset. Do not dissemble The Measure tool
    18. Optional: after impact final femoral stem, may trial femoral head. Reduction , ten final femoral head
    19. Remove all pins
  1. Close capsule
    1. #1 Vicryl suture x2
    2. 3 retractor at greater trochanter
    3. Hibbs Retractor for Posterior Capsula
    4. Hip is at slight internal rotation position
    5. W/ hemostatic forceps x2
  1. Injections:
    1. Remove Trials
    2. Inject Marcaine, Toradol and morphine with epinephrine with Saline up to 60 ml W/ 16 gauge needle , cut off needle protector (CHECK Allergy)
  1. Close of Incision       
    1. Insert 1/8 “ Hemovac Drain with Plier
    2. #1 Vicryl suture for Fascia and  muscle
    3. #2 Stratafix Spiral PDO suture for the retinaculum
    4. # 2-0 Vicryl suture for subcutaneous tissue (#1 Vicryl with Large Needle if  thicker subcutaneous tissue )
    5. Running #4-0 Monocryl suture
    6. Staples for skin
    7. Sterile dressing