Anterior approach to the hip (Smith-Peterson)

open reduction of congenital hip dislocations

synovial biopsies

intra-articular fusions

THA

excision of pelvic tumors

pelvic osteotomies

Superficial

sartorius (femoral n.)

tensor fasciae latae (superior gluteal n.)

Deep

rectus femoris (femoral n.)

gluteus medius (superior gluteal n.)

make long incision following anterior half of iliac crest to ASIS

from ASIS curve inferiorly in the direction of the lateral patella for 8-10 cm

Superficial dissection

identify gap between sartorius and tensor fasciae latae

dissect through subcutaneous fat (avoid lateral femoral cutaneous n.)

incise fascia on medial side of tensor fascia latae

detach origin of tensor fasciae latae of iliac to develop internervous plane

ligate the ascending branch of the lateral femoral circumflex artery (crosses gap between sartorius and tensor fascia latae)

Deep dissection

identify plane between rectus femoris and gluteus medius

detach rectus femoris from both its origins

retract rectus femoris and iliopsoas medially and gluteus medius lateral to expose the hip capsule

adduct and externally rotate the hip to place the capsule on stretch

incise capsule with a longitudinal or T-shaped capsular incision

dislocate hip with external rotation after capsulotomy is complete

Lateral femoral cutaneous nerve

reaches thigh by passing under inguinal ligament

the course is variable and the LFCN can be seen passing medial or lateral to ASIS

injury may lead to painful neuroma or decreased sensation on lateral aspect of thigh

Femoral nerve

should remain protected as long as you stay lateral to sartorius muscle

Ascending branch of lateral femoral circumflex artery

be sure to ligate to prevent excessive bleeding

CORRECT

The anterior Smith-Petersen hip approach uses the superficial internervous plane between the sartorius (femoral nerve) and the tensor fascia latae (superior gluteal nerve). The deep plane for access to the hip joint capsule uses the same internervous plane but is between the rectus femoris (femoral nerve) and the gluteus medius (superior gluteal nerve). In this approach to the hip, one must be conscious to avoid damaging the lateral femoral cutaneous nerve.

The ascending branch of the lateral femoral circumflex artery is at risk during the Smith-Petersen approach to the hip. In this approach, an internervous interval between the femoral nerve (sartorius, superficial; rectus femoris, deep) and superior gluteal nerve (tensor fascia latae, superficial; gluteus medius, deep) is utilized.

The ascending branch of the lateral femoral circumflex artery runs proximally in the internervous plane between the two deep muscles.