Step 1.
Taking the posterolateral approach of the hip joint as an example, the incision was firstly made to determine the vertex of the greater trochanter. 1/3 incision was made at the proximal end of the vertex of the greater trochanter, 2/3 incision was made at the distal end of the greater trochanter, and a slightly oblique incision was made along the posterior edge of the greater trochanter, with a general length of 14-16cm.

Step 2.
Incise the skin, subcutaneous fat and tensor fascia lata, obtuse separate gluteus maximus muscle fibers, use medium muscle to pull two opposite retraction gluteus maximus muscle, expose the external rotation muscle group behind the great trochanter and the fat tissue on its surface and the posterior margin of gluteus medius muscle, obtuse dissection.

Step 3.
Extend the lower extremity and turn inward to expose the external rotator cuff at the insertion behind the greater tuberosity, do you cut off the insertion of the external rotator cuff, the piriformis, the superior gemellus, the obturator internus, the inferior gemellus (or, if necessary, the quadratus femoris)

Step 4.
Bluntness classifies the adipose tissue outside the capsule, exposes the capsule, and makes an incision between the acetabular margin and the trochanter of the femur.

Step 5.
Hip flexion, adduction, internal rotation, so that the center of the foot up, generally dislocation of the joint. The osteotomy plane can be determined by osteotomy plate or medullary cavity file. The length of the femoral calcaneus should be based on the preoperative design, and the average femoral calcaneus 1-5cm vertical femoral neck osteotomy should be retained above the small trochanter

Step 6.
The femoral neck osteotomy must be perpendicular to the coronal plane of the femoral neck and should be consistent with the direction of the prosthetic collar

Step 7.
Extend the lower extremities and rotate inside, using the acetabular retractor to fully expose the acetabular area. Remove osteophytes and capsule around the acetabulum and soft tissue inside the acetabulum, and protect the transverse acetabular ligament

Step 8.
The acetabular cartilage is ground with a acetabular file, which is reduced to a large file until the subchondral bone of the acetabulum is exposed. That is to say, there is even punctate bleeding at the interface

Step 9.
The specification of the acetabular prosthesis is confirmed by the external cup test. Generally, the external diameter of the selected prosthesis (the same as the test) is 2mm larger than the final specification of the acetabular file

Step 10.
Open the metal outer cup of the acetabular prosthesis and connect the corresponding metal outer cup implant bracket and implant rod

Step 11.
Connect the acetabular implant locator to the metal cup implant rod. Pay attention to the position of acetabular notch. Rhythmically hammer the acetabular prosthesis into the rod. Do not use violence until the acetabular prosthesis is completely anastomosed with the osseous acetabulum. Pay attention to the valgus (55 degrees) and anteversion (15 degrees) of the acetabular prosthesis.

Step 12.
Unscrew the metal outer cup and implanted stem, remove the metal outer cup plant kindergarten, according to the stability of the prosthesis implantation after condition to decide whether to use acetabulum screw, using acetabulum screws, first the acetabulum screw seal nut off, through all the wizard drill with universal bit by the acetabulum screw hole drilling, reconfirm by depth gauge length of the acetabulum screws used, screwing in the acetabulum with a screwdriver universal socket head screws

Step 13.
The position of the acetabular notch was confirmed by the relationship between the positioning column of the inner cup on the outer cup rim and the positioning slot on the inner cup rim with the corresponding inner cup test mold implanted. After the position of the prosthesis was confirmed, the inner cup test mold was placed

Step 14.
Both the hip and knee joint flexed 90°, and the hip joint was retracted by internal rotation. The assistant supported the knee joint, and the mouth opener or emei chisel was used to open the intertrochanteric socket along the direction of femoral bone marrow cavity, with a depth of about 1-1.5cm

Step 15.
A soft drill is selected to drill along the femoral bone marrow cavity, with attention to the depth (150mm down from the midpoint of the proximal femoral osteotomy surface). The soft drill should be small to large until it has slight contact with the cortex of the femoral bone marrow cavity, thus confirming the distal diameter of the femoral prosthesis

Step 16.
According to the pre-operative X-ray template and intraoperative measurements, an appropriate size medullary cavity file was selected, and the medullary cavity file was connected with the shaft of the medullary cavity and inserted rhythmically along the femoral bone marrow cavity until 2mm below the proximal femoral osteotomy surface

Step 17.
Remove the shaft of the medullary cavity file from the medullary cavity file, and apply the flat head file to the neck of the medullary cavity file to smooth the proximal femoral osteotomy surface. The proximal femoral osteotomy surface must be smoothed.

Step 18.
Install the collar mold test and metal mold test head. The collar should be in full contact with the osteotomy surface, and the test head should be installed in place. The 49.5mm metal mold test head is the standard head

Step 19.
To reduce the hip joint, check that the position between the femoral prosthesis and the acetabular prosthesis is correct, and it is usually appropriate to maximize the acetabular coverage in the neutral hip position.

Step 20.
After installing the TOP inner cup, femur prosthesis of the same specification as medullary cavity file was selected to connect the impeller and implant the prosthesis rhythmically

Step 21.
If necessary, remove the movable collar bracket of the prosthesis, and use bone grafting spoon and bone grafting rod to implant bone into the groove of the prosthesis, and then fix the collar bracket again. When fixing the collar bracket, the collar bracket is rotated counterclockwise to tighten it

Step 22.
Hammer the neck of the bone prosthesis with a hilt sleeve until the collar rest of the prosthesis is perfectly aligned with the proximal femoral osteotomy face

Step 23.
Drill through the greater trochanter bulge of the prosthesis with a drill bit until penetrating the femoral cortex, and confirm the length of the greater trochanter screw with a depth gauge

Step 24.
Use hexagon screwdriver to screw the large rotor screw

Step 25.
The implant was fitted with a plastic test head, and the hip joint was repositioned. The position of the implant and the tightness of the joint were re-examined to confirm the length of the head and neck of the implant head

Step 26.
Wipe the neck of the stem and install the head

Step 27.
Tap 1-2 times with the head punch

Step 28.
The joint was reduced, the wound was irrigated, drainage was placed, and the incision was sutured intermittently layer by layer