ANTEROLATERAL (WATSON–JONES) APPROACH

USES

This approach is used for hip arthroplasties and drainage of infections around the hip. Campbell calls this the lateral approach. A true lateral approach described by Harris includes a trochanteric osteotomy. The Hardinge approach uses the same interval but splits the tensor and takes the hip abductors off the greater trochanter and retracts them in a posterosuperior direction, exposing the entire anterior. Opening the capsule widely exposes the femoral head and acetabulum.

ADVANTAGES

This is a relatively straightforward approach that allows anterior dislocation of the hip for hip arthroplasties.

DISADVANTAGES

It is possible to denervate the tensor fascia lata if the split into the muscle is too far proximal.

STRUCTURES AT RISK

The major structure at risk is the superior gluteal nerve to the tensor fascia lata muscle. It is important not to split the muscle too far proximally to avoid damage to the nerve. Some surgeons suggest splitting the muscle far enough proximally to identify the inferior branch of the superior gluteal nerve.

It is possible to damage the femoral nerve and artery if you are too far anterior. The medial femoral circumflex could be damaged in the inferior aspect of the dissection if you are cutting down onto the lesser trochanter to release the iliacus or psoas muscles.

TECHNIQUE