Hip – lateral approach

* 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

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