Hip – anterolateral approach

* 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

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