Download Approaches to the hip

Hip
Approach
Indication
Position
Anterior
(Smith
Petersen)
THR
Washout of
septic hip
Open reduction
of congential
hip dislocation
Supine
Anterolateral
(Watson
jones)
THR/hemi
ORIF NOFs
Lateral
Direct Lateral
(Hardgine)
THR
Lateral
Posterior
(Southern)
THR/Hemi
Dependent
drainage of
septic hip
Lateral
Internervous/Inter
muscular plane
Superficial:
Sartorius (femoral)
TFL (Sup glut)
Incision
Superficial dissection
Deep dissection
Dangers
From anterior
iliac crest to ASIS
Curve inferiorly
towards patella
for 8-10cm
Incise fascia on medial
TFL + develop plane
Care to avoid lat cut N
Ligate ascending
branch of lat fem
circum artery
Identify plane b/w RF _
glut med
RF medially
Glut med laterally
Adduct + ex rot leg
T capsulotomy
Lateral femoral cut N
Femoral nerve
Ascending branch of lat fem
circumflex artery
Curved from
2.5cm post +
distal to ASIS
incision 10cm
centred on post
1/3 GT
In line with incision
Incise fascia in line w/
fibres
Retract Glut med
posteriorly
Retract TFL anteriorly
Release origin of vastus
lateralis + retract
inferiorly
T shaped capsulotomy
Intermuscular
Split Glut med
Split Vastus
lateralis
Straight centred
on GT
5cm above + 8 cm
below
Split fascia lata +
retract anteriorly
Detach glut med fibres
Intermuscular
Glut max split
Start 7cm above +
post to GT
10-15cm curved 1
inch posterior to
GT
Incise fasic lata +
uncover vastus
lateralis
Split glut max
Split glut med from
middle GT 3-5cm
Extend through vastus
lateralis + take with glut
min as anterior flap
T capsulotomy
Internally rot leg to
stretch external rotators
Detach Piriformis +
obturator internus +
reflect back
T capsulotomy
Femoral N – risk of
compression/damaged by
retractors in iliopsoas
Femoral A+V – damaged by
retractors in iliopsoas
Abductor limp – disruption of
abductor mechanism
Femoral shaft #
Sup glut N – runs b/w glut med
+ min 3-5cm superior GT
Femoral N – risk of compression
Deep:
Rectus femoris
(Femoral)
Glut med (Sup glut)
Intermuscular
TFL + glut med (sup
glut N)
Sciatic N – extend hip + knee
Inf Glut A
1st perforator of prof. femoris
Femoral vessels
Sup glut A + N
Quadratus femoris
Heterotropic ossification
Medial
Open reduction
congenital
dislocation
Supine +
leg flexed,
abducted
+
externally
rotated
Superficial
intermuscular:
Add longus +
gracilis (Obturator)
Deep internervous:
Add brevis (Ob) +
magnus (sciatic)
3cm below pubic
tubercle
Longitudinal in
line with
adductor longus
Develop plane b/w
gracilis and add longus
Develop plane b/w add
brevis + magnus
Med fem circumplex A
Obturator N
Deep external pudendal A