Operative approaches: Hip

  • In an appropriately marked and consented anaesthetised patient. I would complete the WHO checklist.
  • Patient would be in the lateral position.
  • Incision: 5cm proximal to the tip of the Greater Trochanter, extends down line of femur around 8cm.
    Superficial dissection: Skin, subcut tissue, split fascia lata and retract anteriorly to expose gluteus medius.
  • Deep dissection: Split the gluteus medius longitudinally starting at the middle of the greater trochanter. Do not extend more than 3-5cm above the GT to prevent injury to the superior gluteal nerve. Extend inferiorly through Vastas Lateralis.
  • Expose anterior joint capsule – T Shaped capsulotomy
  • External rotation to dislocate
  • In an appropriately marked and consented anaesthetised patient.
  • I would complete a WHO checklist.
  • Patient would be positioned in the lateral decubitous position. 
  • Incision: 10-15cm curved starting 7cm posterior and superior to GT. 2cm posterior to Posterior GT and then down shaft of femur.
  • Superficial dissection: Skin sub cut fascia. Incise fascia lata. Split Gluteus maximus proximal aspect of wound
  • Deep dissection: internally rotate the hip and divide the short external rotators. 
  • Incise the capsule with a T shaped incision.
  • Dislocate the hip with internal rotation. 
  • In an appropriately marked and consented anaesthetised patient. I would complete a WHO checklist. 
  • Patient would be supine on the table.
  • Internervous plane: superior gluteal and femoral nerve
  • Incision: 8-10 cm. ASIS to lateral border of patella
  • Superficial dissection: Skin, subcut tissue and divide sartorius and Tensor fascia lata
  • Deep dissection: Rectus femoris and gluteus medius
  • Dangers: circumflex arteries, lateral femoral cutaneous nerve, femoral nerve, ascending branch of lateral femoral circumflex artery.
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