Regarding patient positioning, imagine the foot is on your left and the head of the patient is on your right; the leg is dropped down on the table. The end of the bed handily pushes the femur right into the surgical field. Now you can utilize straight reamers with this exposure using the table.
Excellent exposure and a single offset broach handle are simple. Not only can you calcar plane, but you can get good rotational stability. In addition, using a table allows for maximum control of femoral aversion. Frankly, you can almost complete the operation with no retractors.
Although I do not use a C-Arm, which has always been a criticism of the anterior approach, I do feel it’s important to get at least one radiographic representation. To quote another faculty member, “An intraoperative X-ray makes you accept nothing short of perfection.”
You say you want more, Dr. Keggi? Okay! The table makes it easy to incorporate computer navigation and renders revision surgery much simpler.
The table shows up on time, stays late with no lunch breaks, does not call in sick, and can be depreciated. The table is my best friend. And now I must leave you to learn how to tango.
Dr. Bolognesi: John Keggi, do you believe any of that? Tell us your truth.
Dr. Keggi: That was great, Stefan, but I have 10 reasons why you are wrong.
The only table you really need is—a simple picnic table—or a classic OR table.
Here is why.
#10: Cost. Why buy a table when you already have one in the OR? We don’t have a maintenance contract to the extent that you have to have for these other things. You don’t have to pay fluoro techs and you don’t need any special storage.
#9: Availability. I don’t want to fight with my partners, much less my enemies, over the use of the table. If we did go down this path, we would have to buy multiple tables. Not having a special table avoids that conflict.
#8: Set Up. When you don’t use a special table, the set up is very straightforward. You use one gel bump and you’re done. Are you listening, Stefan? The gel bump is placed underneath the hip at the sacroiliac joint and off we go to perform the total hip.
