The anterior approach to the hip provides access to the hip joint and ilium through an incision along the anterior half of the iliac crest down to the ASIS, developing the internervous plane between the sartorius and TFL superficially and between the rectus femoris and gluteus medius deeply to expose the hip joint capsule for procedures like THA, pelvic osteotomies, and tumor excisions while avoiding injury to the lateral femoral cutaneous nerve and ligating branches of the lateral femoral circumflex artery.

1. ANTERIOR
APPROACH TO THE
HIP
Presented by: Dr. Sachin. M.
2nd year PGT, Dept. of Orthopaedics, SMCH
Moderator: Dr. A. K. Sipani
Prof & HOD, Dept. of Orthopaedics, SMCH

2. INTRODUCTION
• Also known as Smith – Peterson approach
• Provides access to the hip joint and the ilium
• INDICATIONS:
• Open reduction of CDH
• THA, Hemiarthroplasty
• Synovial biopsies, irrigation and debridement of the hip joint
• Intra-articular fusions
• Excision of the tumors, especially of the pelvis
• Pelvic osteotomies

3. POSITION AND PREPARATION
• Anaesthesia:
• Spinal block or general
anaesthesia
• Position of the patient:
• Supine
• Use sandbag in cases of
pelvic osteotomies

4. INTERNERVOUS PLANE
• Superficial:
• Sartorius – femoral nv.
• Tensor fasciae latae – superior
gluteal nv.

5. INTERNERVOUS PLANE
• Deep:
• Rectus femoris – femoral
nv.
• Gluteus medius – superior
gluteal nv.

6. LANDMARKS
• Iliac crest: subcutaneous and easily palpable
• ASIS: move anteriorly along the iliac crest to feel a bony
prominence
• Easily palpable in thin patients

7. INCISION
• 8 to 10cm incision along the
anterior half of the iliac crest
up to ASIS
• Curve the incision inferiorly,
extend vertically (8 to 10cm)
directing towards the lateral
side of the patella

8. SUPERFICIAL DISSECTION
• Identify the interval between
sartorius and TFL
• Dissect through the
subcutaneous fat (avoid LFCN)

9. SUPERFICIAL DISSECTION
• Incise fascia on the medial
border of TFL
• Detach TFL from its iliac origin
to develop internervous plane

10. SUPERFICIAL DISSECTION
• Ligate the ascending branch of lateral
femoral circumflex artery

11. DEEP DISSECTION
• Identify the interval between
the rectus femoris and the
gluteus medius
• Detach rectus femoris from
both its origins

12. DEEP DISSECTION
• Retract rectus femoris and
iliopsoas medially and gluteus
medius laterally – exposes the
capsule of hip joint

13. DEEP DISSECTION
• Abduct and ER the hip joint to
place the capsule on stretch
• Make a longitudinal or T-
shaped capsular incision

14. EXTENSION OF APPROACH
• Proximal:
• Required for bone graft harvesting from
the iliac crest
• Extend the incision along the iliac crest
posteriorly
• Distal:
• For intra-operative fracture of femur
• Extend the distal incision downward along
anterolateral aspect of the thigh; incise
TFL in line with skin incision
• Stay in the interval between vastus
lateralis and rectus femoris

15. DANGERS
• Lateral femoral cutaneous nerve:
• Passes under the inguinal ligament
• Variations are common – courses
either medial or lateral to ASIS
• Avoid injuring the nerve while
incising the fascia between sartorius
and TFL
• Femoral nerve:
• Stays in the femoral triangle
• Safe as far as we stay lateral to the
sartorius muscle

16. DANGERS
• Ascending branch of lateral
femoral circumflex artery
• Usually found in the interval
between sartorius and TFL
• Ligate to avoid excessive
haemorrhage