Anterolateral approach to the hip (Watson-Jones)

Between

tensor fasciae latae (superior gluteal nerve)

gluteus medius (superior gluteal nerve)

make 15 cm straight longitudinal incision centered over the tip of the greater trochanter (crosses posterior 1/3 of trochanter before running down the shaft of the femur)

incise fat in line with incision and clear fascia lata

incise fascia

develop interval between tensor fasciae latae and gluteus medius

externally rotate the hip to put the capsule on stretch

identify origin of vastus lateralis

detach abductor mechanism by one of two mechanisms

trochanteric osteotomy

partial detachment of abductor mechanism

expose anterior joint capsule

detach rectus femoris from the joint capsule to expose the anterior rim of the acetabulum

elevate part of the psoas tendon from the capsule

Perform anterior capsulotomy

dislocate hip with external rotation

Femoral nerve

most common problem is compression neuropraxia caused by medial retraction

Femoral artery and vein

can be damaged by retractors that penetrate the psoas

Abductor limp

cause by GT osteotomy and disruption of abductor mechanism

Femoral shaft fractures

usually occurs during dislocation (be sure to perform and adequate capsulotomy)

There is no difference in early gait kinematics between the two approaches

Despite the recent enthusiasm for minimally invasive hip surgery, there has been no proven benefit with regards to early post-operative gait kinematics when comparing the minimally invasive Watson-Jones approach with the more traditional transgluteal approach in total hip arthroplasty (THA).

The minimally invasive Watson-Jones approach involves making an incision 8cm in length from the anterior tubercle of the greater trochanter on a line running from the trochanteric crest to the anterior superior iliac spine (ASIS).The interval between the gluteus medius and the tensor fascia lata is then identified and an extra-articular exposure of the capsule can be obtained.