Hip – Anterolateral (Watson Jones)

Watson Jones

Position

  • supine
  • buttock over hangs over edge of table
  • tilt table away so patient lies flat
  • prep & drape leg free

Landmarks

  • ASIS
  • Greater trochanter
  • Shaft of femur

Incision

  • Flex the hip 30° & adduct
  • 15cm straight longitudinal incision centered over the tip of the greater trochanter

Internervous Plane

  • Tensor fascia lata
    • Superior gluteal nerve
  • Gluteus medius
    • Superior gluteal nerve

Superficial Dissection

  • Continue the incision through subcutaneous fat down to deep fascia
  • Identify & expose the fascia lata by pushing the fat off using blunt dissection
  • Incise the fascia lata longitudinally in line with its fibres in the direction of the ASIS
  • Exposes underlying Vastus lateralis
  • Identify interval between TFL & gluteus medius using blunt dissection
    • Retract gluteal lateral & proximally to expose joint capsule
  • Fully ER leg to stretch joint capsule
  • Identify the Vastus Lateralis ridge
    • Using diathermy reflect the muscle inferiorly 1 cm

Deep Dissection

  • Detaching the abductor mechanism – if needed
    • 1. Trochanter Osteotomy
      • starting at Vastus Lateralis Ridge
        • straight
        • Chevron
      • Use
        • Gigli saw
        • Osteotome
        • Saw
    • 2. Detaching Gluteus Medius
  • Exposes Hip Joint Capsule

Dangers

  • Nerve
    • Femoral nerve
  • Vessels
    • Femoral artery & vein
    • Profunda femoris artery