OrthoNet

Hip - posterior approach
Moore/southern

* position - lateral decubitus

* incision - 15cm curved incision centered on post. edge of GT
- curve towards PSIS or @ 30 deg. angle

* no internervous plane

* dissection
- incise fascia latae to expose vastus lateralis
- split fibers of GMax in line with fibers
- retract fibers of spit GMax
- ID short ER
- ID sciatic nerve
- IR hip to put short ER on stretch & pull operative field farther from sciatic n.
- stay sutures in piriformis & obturator internus tendons
- detach short ER from femur (piriformis, sup. gem., obt. int., inf. gem)
- may need to detach sup. border of quad. fem.
- reflect muscles backward to protect sciatic n.
- incise capsule
- dislocate hip

* dangers
- sciatic n. - always ID & protect

- IGA - leaves pelvis beneath piriformis & heads cephalad to supply deep surface of GMax
- branches cut with splitting of GMax

- cruciate anastomosis
> at lower border of QF
> anastomosis of ascending branch of 1st perforator, descending branch of inf. epigastric art., med. & lat. fem. circumflex art.