OrthoNet

Hip - anterior approach
Smith-Peterson approach

* position - supine +/- sandbag under affected hip

* incision
- long icision following ant. half of iliac crest to ASIS
- curve incision 8-10cm to run vertically down thigh towards lat. aspect of patella

* internervous plane
- sartorius (fem. n.) & TFL (sup. gluteal n.)
- rectus femoris (fem. n.) & gluteus medius (sup. gluteal n.)

* dissection
- ER leg to stretch sartorius
- ID gap btw TFL & sartorius usu 2-3 in below ASIS
- dissect down thru subcut. fat along intermuscular interval avoiding lat. fem. cut. n. –> pierces deep fascia of thigh close to interval
- incise deep fascia on med. side of TFL
- detach origin of TFL to develop plane
- ascending branch of lat. fem. circumflex art. crosses btw TFL & sartorius
- detach rectus from both origins (AIIS & sup. lip of acetabulum)
- adduct & ER leg to put capsule on stretch
- incise hip capsule either long. or t-shaped

* dangers
- lat. fem. cut. n.
> reches thigh by passing over, behind or thru sartorius 2.5 cm below ASIS
> beware of nerve when incising fascia btw TFL & sartorius

- femoral n. - lies directly ant. to hip joint in fem. triangle & well med. to rectus femoris

- ascending branch of lat. fem. circumflex art. - crossed field prox. btw TFL & sartorius