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Flashcards in Hip Approaches Deck (30):
1

position for anterior (Smith-Petersen) approach to the hip

supine

2

incision for anterior (Smith-Petersen) approach to the hip

long incision on anterior half of iliac crest to ASIS, then veers vertical toward the lateral aspect of the patella for 10 cm

3

plane for anterior (Smith-Petersen) approach to the hip

superficial: between sartorius and TFL
deep: between rectus femoris and glut med

4

superficial dissection for anterior (Smith-Petersen) approach to the hip

-external rotation to stretch sartorius
-ID gap between TFL and sartorius
-incise fascia medial to TFL
-retract medial and lateral
-detach TFL from ileum
-ligate ascending branch of the lateral femoral circumflex artery

5

deep dissection for anterior (Smith-Petersen) approach to the hip

-ID rectus femoris - glut med interval, which should be well lateral to femoral artery
-detach rectus femoris and move medially
-retract glut med laterally
-retract iliopsoas and detach fibres that may attache to inferior hip joint
-externally rotate
-T-shaped capsulotomy
-dislocate with external rotation

6

danger (3) for anterior (Smith-Petersen) approach to the hip

1. LFCN lies on sartorius
2. FN lies over hip joint medial to rectus femoris
3. must ligate ascending branch of lateral femoral circumflex artery

7

position for anterolateral (Watson-Jones) approach to the hip

supine, buttock off edge of table, tilt away from you

8

incision for anterolateral (Watson-Jones) approach to the hip

with the leg flexed 30° and adducted, make a 8-15 cm longitudinal incision centred over the GT and down the femoral shaft

9

plane for anterolateral (Watson-Jones) approach to the hip

none really, but just don't dissect to the origin of TFL - where it is innervated

10

superficial dissection for anterolateral (Watson-Jones) approach to the hip

-incise fascia lata and cut antero-superiorly to the ASIS and distal to expose vastus lateralis
-blunt dissection to find glut med
-retract TFL medial and glut med lateral
-externally rotate to stretch capsule
-incise and reflect the uppermost 1 cm of vastus lateralis to expose the joint

11

deep dissection for anterolateral (Watson-Jones) approach to the hip

-chose either i) trochanteric osteotomy or detach abductors at tendon with stay suture
-retract rectus and iliopsoas medially
-H-shaped capsulotomy
-dislocate hip with external rotation

12

danger (4) for anterolateral (Watson-Jones) approach to the hip

1. FN injury with aggressive medial retraction
2. FA/FV damage if retraction through iliopsoas
3. profunda femoris lies on iliopsoas
4. femoral shaft prone to # with dislocation maneuvers when there is an incomplete capsulotomy

13

position for lateral approach to the hip

supine, buttock over the edge of the table

14

incision for lateral approach to the hip

5 cm rostral to GT, centred over it. to 8 cm down the femoral shaft

15

plane for lateral approach to the hip

none - split glut med and vastus lateralis

16

superficial dissection for lateral approach to the hip

-incise fascia to pull TFL anterior and glut max posterior

17

deep dissection for lateral approach to the hip

-split glut med starting at GT and going no more than 3 cm rostral
-split vastus lateralis
-develop glut med, glut min, vastus lateralis as an anterior flap
-detach insertion of glut min
-blunt exposure of capsule
-T-shaped capsulotomy
-osteotomize femoral neck
-extract head

18

danger (4) for lateral approach to the hip

1. SGN runs between glut med and min 3-5 cm rostral to GT
2. FN runs on psoas, so anterior retractors should only be placed on bone
3. FA/FV run medial to nerve but could be injured if retraction too medial
4. transverse branch of the lateral femoral circumflex artery must be ligated as vastus lateralis is cut.

19

position for posterior approach to the hip

true lateral

20

incision for posterior approach to the hip

10-15 cm curved incision centred on the posterior aspect of GT in line with the glut max fibres

21

plane for posterior approach to the hip

none - split the fibres of glut max

22

superficial dissection for posterior approach to the hip

-incise fascia to expose vastus lateralis
-split glut max proximally, bluntly

23

deep dissection for posterior approach to the hip

-protect sciatic nerve
-internally rotate hip to stretch SERs
-stay suture in piriformis and OI then detach and retract
-try to leave QF (much lateral circumflex bleeding)
-T-shaped capsulotomy
-dislocated with internal rotation

24

danger (2) for posterior approach to the hip

1. sciatic nerve emerging from beneath piriformis
2. IGA emerging under piriformis

25

position for the medial approach to the hip

supine, affected side in frog leg position

26

incision for the medial approach to the hip

longitudinal along the medial thigh starting 3 cm below the pubic tubercle running over adductor longus

27

plane for the medial approach to the hip

superficial: between longus and gracillus
deep: between brevis and magnus

28

superficial dissection for the medial approach to the hip

-gracillus and longus plane --> retract
-ID anterior division of obturator nerve
-magnus and brevis --> retract
-ID posterior division of obturator nerve

29

deep dissection for the medial approach to the hip

-feel for LT
-place bone spike above and below LT to isolate iliopsoas tendon

30

danger (3) for the medial approach to the hip

1. anterior ON lies on OE and brevis
2. posterior ON goes through OE and lies on magnus
3. MFCA passes around medial and distal to psoas tendon