At first glance, the Hana table might resemble a medieval torture device, but it is actually an operating table used to aid orthopedic surgeons during the Direct Anterior Approach. Developed by California-based Mizuho OSI, the table’s name – Hana® – is an acronym that stands for Hip And kNee Arthroplasty surgical table.
In this post I will discuss the Hana table and how it works. This will increase your knowledge of the anterior hip replacement approach and it will give you an idea what will happen to you or your loved one during surgery. Please note, some of the information may be a little graphic for those who are squeamish.
Hana Table – What It Does
The Hana table can also be used in knee replacements, fractures and other surgery types dealing with the knee, hip and femur. However, in this post, I will only be discussing the Hana table’s use during the anterior hip replacement approach.
It is unlikely you will ever see the Hana table unless:
- You catch a glimpse of it in the operating room when you are wheeled in (before you go under sedation)
- Your surgeon or hospital shows you the table during your operation orientation
When I had my hip replacement surgery, it was performed on the Hana table using the direct anterior approach. I only had my left leg hip replaced, but the Hana table can be especially helpful to replace both hips at the same time, called bilateral hip replacement. I did not notice the Hana table in the operating room as the table was apparently draped and blended in with other equipment in the operating room.
So, you might ask why this table is used instead of a regular operating table? For the direct anterior approach for hip replacement, the Hana table permits exposure and visualization for the surgeon from a small incision at the front of the hip. Using the controls of the Hana table the surgeon can create:
- A – Hyperextension and external and internal rotation of the leg – The rotation is locked with a knob.
- B – Adduction – By lowering the ‘leg spar’ toward the ground, the front of the femur is raised to provide better visibility for the surgeon. This allows the top of the femur to be more easily removed, the bones more easily prepared for the implants, and the implants more easily and accurately placed.
Anterior hip replacement approach using the Hana table results in the following benefits to the patient and surgeon:
- Less tissue trauma
- Less pain
- Less stress on the patient
- The patient can lie flat on the table instead of on the side
- Reduced time in surgery
The Hana table can handle patients who weigh up to 450 lbs. Some experts claim very obese or muscular patients have good success when orthopedic surgeons use the Hana table. These patients are usually at risk for hip replacement surgery, but are now candidates for experienced orthopedic surgeons who use the Hana table.
C – High Quality Medical Mattress Pad – Aids in patient comfort.
Accuracy of leg length and implant placement is increased using the Hana table with video X-ray or Fluoroscopy (a type of X-ray showing live video of a concentrated area of the body).
The patient awaiting hip replacement lays on the Hana table right before and during anterior hip replacement surgery. He or she is wheeled into the operating room on the gurney used during operation prep. Here, the Hana table is ready and waiting for the surgery. It is sterilized and draped to prevent any contaminants that were created from the table’s movement from entering the surgery area.
- After sedation, the patient is gently lifted from the gurney on to the Hana table using a special transfer board.
- A catheter is likely inserted, fluoroscopy cameras set up along with devices which monitor the patient’s vital condition. The patient’s arms are secured to the removable arm rests on the side of the Hana table.
- D – Center Post – placed in the table between the legs of the patient, near the crotch, to keep the patient from sliding down
- The patient’s arms are secured to arm boards located to the right and left of the table
- The patient’s legs are rested on boards and his or her feet are wrapped with boot liners to protect the feet when placed in the boots.
- E – Radiolucent Carbon Boots or Traction Boots – placed around the patient’s feet and the flaps from the boots closed over them. The boots are clearly marked left and right so there is no accident or delay during surgery preparation. The radiolucent carbon does not block the imagery required by the surgery,
- The boots are securely locked to the gross traction, see ‘F’ below, using a post at the bottom of the boot
- The board the legs rested on are removed once the traction boots are attached to the gross traction
Since the Hana table is connected to electricity, the surgeon can lift the table ‘G’ with a pedal located on the ground. This reduces the account of hand manipulation of the table. The table top and leg spars are mounted to a stainless steel pedestal with a replaceable modular control panel.
Hana Table – H – Leg Spars
Radiolucent carbon fiber leg spars extend from the left and right of the table. The leg spars have handles at the end to release the spar and provide several movement controls for traction adjustment, hyperextension, adduction, abduction and rotation, required to perform hip replacement surgery on the patient. A handle at the end of the leg spar allows the surgical team to raise or lower the leg or move it from side to side. Precautions must be taken here. Gross traction cannot be locked when the leg spar is dropped to the ground, as this could cause severe nerve damage to the patient. As with the traction boots, the radiolucent carbon fiber in the leg spars provides uninterrupted fluoroscopy imaging, meaning the video X-rays are not blocked by the machine.
Hana Table – F – Gross Traction
The boot attaches to the gross traction, and this area of the Hana table moves forward and backward on a slide. There is a knob on the gross traction that locks or unlocks the slide or the sled. As part of the anterior approach for hip replacement, the hip must be dislocated, and the gross traction permits this by rotating the hip outward. The twist knob at the end pulls on the leg, separating the femur ball from the socket (acetabulum). The controls allow very small adjustments to the leg. A handle at the end of the leg spars allow the surgical team to raise or lower the leg or move it from side to side. Care must be taken here. The gross traction cannot be locked when the leg spar is dropped to the ground, as this could cause severe nerve damage to the patient.
Hana Table – Femur Hook (Not Shown)
The one component to the Hana table which made me a little squeamish is the femur hook. When used, it is mounted to the side of the table. When the femur is dislocated and exposed, the hook can be used to help expose the top of the femur during the anterior approach of total hip arthroscopy and assist in the placement of the prosthesis. Afterwards in this position, the artificial hip can be inserted into the femur (it is hammered in if no cement is used).
Hana Table – Conclusion and Engagement
What are your thoughts about the Hana table? Are you preparing to have the anterior approach for hip replacement using the Hana table? Has your doctor discussed any of the procedures with you or described how the Hana table is used? Do you think it helps knowing what happens in the surgery, or is it better no knowing? Are you a surgeon or nurse who would like to leave a comment or addition?
If you think this information is valuable to prepare those having the anterior approach for hip replacement, please share this post with them and help them understand what will happen during surgery.
Thanks for reading my blog and this post. If you have any questions or comments please make them in the space below or engage with me on Twitter or Facebook.
D.P.V.: The Latest Procedure: Anterior Approach Total Hip Replacement Surgery, https://www.youtube.com/watch?v=5nqja_j2dfw.
The HANA table is good news for surgeons and their patients, http://www.macombdaily.com/article/md/20130130/life02/130139977.
L.C.M.C.M.C.: Hana Table for Anterior Approach Hip Replacement, https://www.youtube.com/watch?v=jlt0ppukueg.