This technique does not include the use of a special traction table (i.e., Hanna table).
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Position the patient supine on the operating room table so that the bend of the table is at the level of the symphysis pubis. This will allow extension of the hip joint and elevation of the proximal femur during preparation of the femur. Place an arm board distally on the contralateral side of the operative leg, parallel to the table so that the nonoperative hip can be abducted to allow adduction of the operative hip.
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Make an oblique incision beginning 2 to 3 cm lateral and 2 to 3 cm inferior to the anterior-superior iliac spine in line with the tensor fascia latae (TFL) muscle ( Figure 3-1 ).
Figure 3-1
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Carry dissection distally and laterally over the TFL down through the subcutaneous tissue to the level of the fascia of the TFL. The fascia at this location is relatively translucent and the pink/red muscle may be easily observed. If one is either too far medial or lateral, the fascia is not as translucent and is white in color.
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Sharply split the fascia longitudinally in line with the muscle fibers, and carry dissection medially to develop the interval between the sartorius and TFL muscles. Because this dissection is within the tensor sheath, the sartorius muscle may not be visible ( Figure 3-2 ).
Figure 3-2
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Carry dissection deeper in this interval between the gluteus medius and rectus femoris and place soft-tissue retractors to retract the rectus femoris medially and the gluteus medius laterally.
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Several large vessels lie between these two muscles (divisions of the ascending branch of the lateral femoral circumflex artery); carefully ligate or cauterize these. It is important to ligate or cauterize these in situ before dividing them because they can retract into the soft tissues and cause excessive bleeding ( Figure 3-3 ).
Figure 3-3
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Dissect the rectus femoris muscle (on the deep side of it), just anterior to the hip capsule and carry dissection medially. Place a self-retaining retractor to retract the TFL laterally and the rectus femoris medially.
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Place a cobra retractor extracapsularly along the inferior femoral neck and another retractor in the “saddle” region (junction of the greater trochanter and the superior femoral neck).
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Use a rongeur to remove some of the anterior fat over the hip capsule to expose the capsule.
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Perform a capsulectomy or capsulotomy to allow access to the femoral neck ( Figure 3-4 ).
