OrthoNet

Hip - anterolateral approach
Watson-Jones

* position
- usu in lat. decubitus position
- may use supine position

* incision - 15 cm incision centered on GT, may curve slightly post. proximally

* internervous plane
- no true plane
- btw TFL & gluteus med. (sup. gluteal n.)

* dissection
- incise fat to reach deep fascia
- incise fascia latae at post. margin of GT distally
- ID interval btw TFL & GMax & incise fascia
- retract GMed & GMin prox. & lat. away from sup. margin of capsule
- ER leg to expose joint capsule
- dissect up fem. neck to expose capsule
- may require troch. osteotomy or detachment of ant. 1/3 of GMed
- detach reflected head of rectus
- incise hip capsule (H-shaped)
- dislocate hip

* dangers
- fem. n. - most lat. placed structure in fem. triangle & can be stretched with overzealous retraction of ant. tissues

- profunda femoris art. - lies on psoas muscle deep to fem. art. & can be damaged by poorly placed retractors

- fem. art & vein - may be damaged by incorrectly place acetabular retractors that penetrate iliopsoas

- femoral shaft #s - with dislocation of hip or with forced adduction & ER for reaming of shaft