OrthoNet

Hip - lateral approach
Hardinge

* position - supine or lat. decubitus

* no internervous plane

* incision - 15 cm longitudinal incision centered over GT

* dissection
- incise fat & deep fascia in line with incision
- retract TFL ant. & GMax post.
- split fibers of GMed in direction of fibers in middle of GT
- split fibers of vastus lat.
- develop ant. flap of ant. GMed & vastus lat.
- detach muscles subperiosteally from GT or with flake of bone
- detach GMin with flap
- incise capsule (t-shaped)
- osteotomy of fem. neck
- extend capsulotomy
- remove fem. head
- complete exposure of acetabulum

* dangers
- SGN - runs btw GMed & GMin 3-5cm above upper border of GT
- more prox. dissection can cut nerve or produce traction injury

- fem. n. - vulnerable to inapporpriately placed retractors

- transverse branch of lat. fem. circumflex art. - cut as vastus lat. mobilized