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Anterolateral Approach to Hip Joint

 Anterolateral Approach to Hip Joint

Anterolateral Approach to Hip Joint (Watson-Jones) indications:

Anterolateral approach to hip joint (Watson-Jones approach) combines an excellent exposure of the acetabulum with safety during reaming of the femoral shaft in total hip arthroplasty.

It was popularized by Watson-Jones 1981.

Anterolateral approach to hip joint is used for:

  1. Total hip arthroplasty THR:
    • Minimally invasive approach does not improve post-op gait kinematics when compared to traditional trans-gluteal approach.
    • Patient at high risk for dislocation may benefit from antero-lateral approach since no posterior soft tissue disruption.
    • Some concern that this approach can weaken the abductor and cause limping.
  2. Hemiarthroplasty.
  3. Open reduction internal fixation of femoral neck fracture.
  4. Synovial biopsy of hip.
  5. Biopsy of femoral neck.

See Also:

Position of the Patient

  1. Generally anterolateral approach to hip joint is performed in the lateral decubitus position.
  2. Or in the supine position, with the patient’s buttock close to the edge of the table to let fat fall away from incision.
Anterolateral Approach to the Hip

Landmarks and Incision

Landmarks:

Incision:

Internervous plane

 There is no true internervous plane for anterolateral approach to hip joint, since the gluteus medius muscle and the tensor fasciae latae have a common nerve supply, the superior gluteal nerve.

Superficial dissection

Deep dissection

Detach abductor mechanism by one of two mechanisms:

Expose anterior joint capsule.

Detach reflected head of rectus femoris from the joint capsule to expose the anterior rim of the acetabulum: Easier with leg flexed slightly.

Elevate part of the psoas tendon from the capsule.

Perform anterior capsulotomy.

Approach Extension

Distal Extension of the Anterolateral approach to hip joint:

Proximal Extension:

Dangers

The structures at risk during anterolateral approach to hip joint includes:

Femoral nerve:

Femoral artery and vein:

Abductor muscles of the hip:

Femoral shaft fractures:

References


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