Surgical tables are expensive enough as it is. Why would a facility invest in one designed specifically for hip procedures? Well, ask yourself: Are significantly better patient outcomes important to you? These specialty positioning tables and attachments have, over the past decade, made the less-invasive, muscle-sparing anterior approach to total hip arthroplasty more possible and more accessible, to the patient's benefit.

The anterior approach, also known as "direct anterior," enables a surgeon to replace the hip through a single incision without cutting muscle from the femur or pelvis, unlike the posterior approach (the predominant choice) or anterior lateral (which, according to orthopedic observers, leaves 30% of patients with a persistent limp). Less tissue trauma means less post-op pain, but it also leaves the hip stable enough for early post-surgical mobility.

A hip table "acts like a surgical assistant," says one industry expert, providing the leg hyperextension, external rotation and adduction necessary to expose the femur from the front, and it does so more safely, efficiently and reproducibly than can be accomplished by positioning and holding patients on conventional tables.

If you're looking to upgrade your ORs for the anterior approach, here are a few factors observers say you should keep in mind when shopping for a hip table.

• Accommodation. Is its weight capacity sufficient to support not just your patients (including the obese and muscular ones), but also the pressure that surgeons will be applying to the joint? Will its surface effectively pad patients against that pressure? Is its height adjustable to surgeons' demands?
• Positioning. Can it manipulate patients precisely, safely and comfortably? Placing too much traction on the leg can cause nerve palsy, while knee buckling can reduce adduction. Some tables can actually measure positions for reproducible results.
• Imaging access. Is the table's construction imaging-friendly, both in the radiolucence of its materials and in the ability of a C-arm to fit around it?
• Reliability and repair. Some tables include electronic controls that handle the precision for you. Others are hand-driven hardware. In either case, a maintenance service package is a must.
• Economy. Insurers don't pay more for direct anterior than for other approaches, which makes a hip table an expensive piece of equipment to park in the corridor. Table attachments and freestanding positioners that bring hip positioning capabilities to traditional OR tables may offer a more cost-effective option. OSM

Innovative Orthopedic Technologies
Purist Leg Positioning System
iotiot.com
(409) 658-1017
Pricing: $40,000 to $60,000
FYI: The quick setup, staff-friendly operation and compact 2-foot-by-3-foot size of Innovative Orthopedic Technologies' Purist Leg Positioning System brings efficiency and surgeon control to hip replacement cases. The mobile, freestanding, self-stabilizing patient positioner, which works independently but which is compatible with any standard OR table, allows surgeons to precisely control the intraoperative rotation, gross traction and fine traction necessary to perform direct anterior total hip arthroplasty, without assistance from non-sterile personnel. Its ergonomic design features centralized controls and requires no bending or extremes of movement to operate.

Maquet Medical Systems
YUNO OTN Operating Table
maquet.com/us
(888) 627-8383
Pricing: not disclosed
FYI: The modular structure of Maquet's YUNO OTN table allows quick modifications to accommodate a wide range of applications, including femoral procedures. Its leg extension bars provide safe hyperextension, adduction/abduction, and internal/external rotation, without unnecessary pressure and with patient comfort in mind. Carbon fiber components, a stable 3-point base and easily detachable metal side rails enable fluoroscopic imaging access without the need for intraoperative repositioning. The height-adjustable table supports up to 1,000 lbs. of patient weight.

Mizuho OSI
Hana Orthopedic Surgery Table
mizuhosi.com
(800) 777-4674
Pricing: not disclosed
FYI: The patented femoral lift and support system of Mizuho OSI's Hana table safely hyperextends, adducts and externally rotates for enhanced femoral exposure and component placement in anterior approach total hip arthroplasty, hip arthroscopy, and other hip procedures. The cantilevered tabletop is constructed from radiolucent carbon fiber to allow unrestricted C-arm imaging, while a memory foam mattress supports and redistributes pressure beneath patients of up to 450 lbs. The low-profile table makes patient transfers easy, while foot pedal controls give users the power of mid-procedure positioning.

Schaerer Medical
Rotex Table Extension
schaerermedicalusa.com
(800) 755-6381
Pricing: not disclosed
FYI: Convert any surgical table into a hip specialty table with Schaerer Medical's Rotex Table Extension. The motorized positioning platform enables surgeons to intraoperatively control patient leg positioning by way of a foot pedal, eliminating the need to direct and wait for staff to adjust the table. Its design provides easy anterior access to both the surgeon and imaging equipment, and its maneuverability, ease of assembly and small footprint make setup and storage convenient for staff. The Rotex works with most standard surgical tables and supports a weight capacity of 440 lbs.

Smith & Nephew
Hip Positioning System with Active Heel Technology
smith-nephew.com
(978) 749-1000
Pricing: not disclosed
FYI: Smith & Nephew's Hip Positioning System can be configured for use in central compartment arthroscopies by distracting a patient's leg, and can also firmly support and secure patients during peripheral and lateral compartment procedures. A ball joint allows the hip to be easily flexed, abducted or adducted, and the system automatically locks in place to prevent movement after the hip is repositioned. A simple control system facilitates both fine and gross distractions, while the Active Heel traction boot is easily removed and reattached.

Steris
OT 1000 Series Orthopedic Surgical Table
steris.com
(440) 354-2600
Pricing: not disclosed
FYI: The OT 1000 Series table has benefits for every member of your surgical team. Precision controls, unobstructed site access and Steris's proprietary Swan technology give surgeons flexible positioning and patient control for anterior approach hip surgery and fracture reduction. Its easy-grip drive handles and maneuverability allow a single nurse to move the table from room to room with ease. Plus, an articulating headrest improves patient airway access for anesthesia providers.

Stryker
Operon Orthopaedic Extension Unit
stryker.com
(866) 841-5663
Pricing: not disclosed
FYI: Part of Stryker's extensive line of surgical table accessories, the orthopedic extension unit is designed to convert your Operon D Series surgical table from a general purpose surface into a specialty positioner for hip and lower extremity procedures. The high-strength, lightweight, radiolucent carbon fiber device attaches simply and securely to the table with the help of an included cart, in which users can store the extension and accessories between cases. The unit's patient weight capacity is 400 lbs. with leg support and 300 lbs. without.