At the 2019 Orthopaedic Summit: Evolving Technologies (OSET), two orthopedic surgeons debated whether a special OR table was needed for a 69-year-old former professional tango dancer requesting anterior total hip replacement. Arguing for was Stefan W. Kreuzer, M.D., M.S., of INOV8 Orthopedics and against was John Keggi, M.D., of Orthopaedics New England. The debate was moderated by a past president of AAHKS, Michael Bolognesi, M.D.
Dr. Kreuzer: The anterior approach to a total hip replacement (THR) involves a small incision through the Smith-Peterson interval where you go between the tensor fascia latae and the sartorius muscle. No major releases are required, but a special table is very helpful with this approach.
If you have a Cadillac budget, you can select the ProFx table—quite an expensive choice. If you are opting for the economical choice, the Arch Table is a possibility. Note that I do have a financial interest in this table and thus you should take everything I say with a grain of salt. Generally speaking, we needed to come up with a less expensive solution that works well for all our patients.
You could say that the table acts as a quiet, well-behaved surgical assistant. Annually, a surgical assistant can cost between $40-60,000 ($150,000 in New York City). With this table, there is a one-time expense and you get a quality product. It’s very easy to set up, it’s modular, it’s mechanical, there are no electronics, and it can be used for trauma cases as well.
There’s no doubt in my mind that you get better femoral exposure doing an anterior hip replacement with a table. And if you are operating on a muscular NFL football player—which I’ve done quite a bit lately—then it is particularly helpful.
Another key advantage is that you can use a single offset broach handle versus a double offset broach handle. In addition, intraoperative X-rays are rendered much easier with the table.
