Modern surgery, general and operative . sesof long duration, especially where dislocation ex-ists, excision is an easy and a comparatively safeoperation; in recent cases it is difficult and carrieswith it decided dangers, but the peril of delaymay be greater than the peril of an early excision.In cases of hip disease with involvement of theacetabulum the mortality is 50 per cent., whetheroperation is or is not attempted. Excision isperformed especially for tuberculous disease andfor gunshot-injuries.Operation hy Anterior Incision (Fig. 441) {Barkers Operation).—In thisoperation the patient is
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Modern surgery, general and operative . sesof long duration, especially where dislocation ex-ists, excision is an easy and a comparatively safeoperation; in recent cases it is difficult and carrieswith it decided dangers, but the peril of delaymay be greater than the peril of an early excision.In cases of hip disease with involvement of theacetabulum the mortality is 50 per cent., whetheroperation is or is not attempted. Excision isperformed especially for tuberculous disease andfor gunshot-injuries.Operation hy Anterior Incision (Fig. 441) {Barkers Operation).—In thisoperation the patient is supine, with the thighs extended as thoroughly ascircumstances permit. The surgeon stands to the right of the patient. Anincision is begun ^ inch below and | inch external to the anterior superior iliacspine, and it is carried downward and a little inward for about 3 inches (Fig.441, d). If dislocation exists, the incision need not be so long. This incisionis carried at once deeply between the muscles, and the capsule of the joint is. Fig. 441.—Excision of the hip-joint: A, Gluteus muscle; b, tensorvaginae femoris muscle; c, sar-torius muscle; D, anterior incision. Excision of the Knee-joint 703 opened. The neck of the bone is divided from its upper surface downward bya saw or an osteotome, and without dislocating the bone through the wound byforcible extension and eversion. The head of the bone is removed. All tuber-culous foci must be scraped away, and the flushing gouge is used upon tubercu-lous areas of the acetabulum. All sinuses should be thoroughly scraped.Bleeding is arrested, the wound is irrigated with normal salt solution, moppedwith chlorid of zinc solution, and dusted with iodoform. A drainage-tubeis inserted at the lower angle of the incision, and the upper portion of the cutis closed. The wound is dressed antiseptically. Extension is made by theextension apparatus until healing has obtained good headway, when a doubleThomas splint is applied, so that the pati