- See:
Watson Jones Approach:
- Discussion:
- Smith Petersen improved & revived the anterior
iliofemoral approach;
- entire ilium and hip joint can be reached thru iliac part of incision;
- w/ this approach there is a need for extensive detachment of tendinous insertions & retraction of muscle, w/ potential damage to
femoral artery and nerve
and traction on lateral femoral cutaneous nerve;
- among the indications for this approach are
ganz osteotomy for DDH and
posterior hip frx dislocations;
- Technique:
- begin incision at middle of iliac crest or, farther posteriorly if required;
- accentuate the gap between the tensor fascia lata and sartorius by external rotation of the thigh;
- divide the overlying fascia w/ scissors takeing care to avoid damaging
lateral femoral cutaneous nerve:
- this nerve passes over
sartorius 2.5 cm distal to ASIS;
- it pierces deep fascia of thigh 7 cm below ASIS;
- identify the nerve and retract it medially with
sartorius;
- identify ascending brach of
LFCA, which lies 5 cm distal to hip joint;
- divide the superficial and deep fascia, and free the attachments of
gluteus medius &
tensor fasciae latae from iliac crest
- strip periosteum w/ attachments of medius & minimus muscles from lateral surface of the ilium;
- continue dissection thru deep fascia of thigh & between
tensor fascia lata laterally & sartorius & rectus femoris medially;
- this exposes medius & rectus femoris;
-
rectus femoris is detached from its two origins:
- straight head from AISIS
- reflected head from the anterior lip of acetabulum
- at this point, capsule of hip joint is exposed;
MINIMALLY INVASIVE TOTAL HIP ARTHROPLASTY WITH THE SHORTENED SMITH-PETERSON ANTERIOR APPROACH
