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The development of safe and reliable surgical approaches to the hip has allowed successfully hip replacement surgery to take place. There are essentially five main approaches to the hip joint –anterior, anterolateral, direct lateral and posterior.Each main approach has several different variants described and some of these modifications can be confusing if you haven’t seen them firsthand at surgery.Each approach takes advantage of muscular planes around the hip.Each approach has inherent advantages and disadvantages.No approach can claim to be perfect

  • The anterior approach utilizes the interval between the sartorius medially and tensor fascia laterally.
  • The anterolateral approach uses the interval between the tensor fascia and the gluteus medius.
  • The direct lateral approach is essentially dependent upon elevation of the insertion of the gluteus medius and minimus.
  • The posterior approach involves detaching the short external rotators from the femur
  • Anterior(Smith-Peterson)
  • Anterolateral(Watson Jones)
  • Direct lateral approach/transgluteal (Charnley approach,Hardinge)
  • Posterior(Moore)
  • Medial

The ideal surgical approach must allow for good exposure
It should be safe,technically easy and extensile
It should be reproducible and have evidence of efficacy and published results

  • Talk about the approach you use and know
  • Don’t describe something that you have vaguely read in a textbook
  • Know in particular the extensile measures and internervus planes

Surgical Approaches to the hip
A baseline system

  • Indication
  • Position of patient on operating table
  • Surgical landmarks and incision
  • Inter nervous plane/ inter muscular plane
  • Superficial surgical dissection
  • Deep surgical dissection
  • Structures at risk-nerves,vessels and muscles/tendons
  • How to enlarge the approach

Local measures
        Extending skin incisions,repositioning retractors,detaching muscles,adjusting light source
Extensile approach
         To include adjacent bony structures

  • Closure of the wound
  • When describe the posterior approach hip mention placing retractors anterior and inferiorly .This demonstrates/suggests that  you have actually performed the approach yourself rather than read it from a book.
  • Surgical approaches is definitely a last minute brush up revision of short notes made in the week before  exam.The key is spending a few days writing these approaches down   


93.A child presents with a septic hip and an anterior approach is performed to irrigate and drain the joint.  Regarding this approach, a nerve is at risk as it passes deep to the fascia lata and crosses the lateral border of a muscle which is retracted during the approach. 
What is this muscle?


1. Rectus femoris
2. Sartorius
3. Tensor fascia lata
4. Vastus intermedius
5. Vastus lateralis