Hip – posterior approach

* 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.

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