Hip – Direct Anterior (Smith Peterson)

Position

  • supine

Landmarks

  • ASIS
  • Iliac crest

Incision

  • Curved longitudinal incision
  • Runs along the anterior half of the iliac crest to the ASIS
  • Then vertically down anterior thigh for 8 cm

Internervous Plane

  • Superficial
    • Sartorius
      • Femoral nerve
    • Tensor fascia latae
      • Superior gluteal nerve
  • Deep
    • Rectus femoris
      • Femoral nerve
    • Gluteus medius
      • Superior gluteal nerve

Superficial Dissection

  • Deepen the incision
  • Being careful to avoid damaging the Lateral Femoral cutaneous nerve of the thigh
  • ER leg to stretch Sartorius to make it more prominent
  • Identify the gap between TFL & sartorius
    • Develop this plane
    • Superiorly near the ASIS
      • Ascending Branch of Lateral femoral circumflex artery must be ligated

Deep Dissection

  • Identify Rectus femoris & Gluteus medius
  • Detach the Direct & Reflected heads of Rectus from its origins & retract it medially
  • Retract Gluteus medius laterally
  • Exposes hip joint capsule
  • Iliospoas is often partly attached to inferior aspect of hip joint capsule & must be released from it
  • Adduct & IR leg to stretch & define capsule
  • T shaped capsular incision

Dangers

  • Nerves
    • Lateral femoral cutaneous nerve
    • Femoral nerve
  • Vessels
    • Ascending branch of lateral femoral circumflex artery