Surgical Anatomy of the Anterior Hip and Thigh



Surgical Anatomy of the Anterior Hip and Thigh


John V. Horberg

Benjamin R. Coobs





Introduction

The DAA was first described as a surgical interval by Carl Hueter1,2 in 1883 and was initially popularized in North America by Marius Smith-Petersen in 1917.2,3,4 The approach has steadily gained in popularity over the course of the past few decades as it has been adapted for total hip arthroplasty (THA), among many other uses. Preservation of the posterior musculature makes postoperative restrictions unnecessary, and the use of a true internervous plane has been shown to speed early postoperative recovery and mobilization. In this chapter, the relevant surgical anatomy necessary to safely expose the hip using the anterior interval is discussed and illustrated.


Superficial Anatomy and Surgical Landmarks



















  • Anterior superior iliac spine (ASIS): The ASIS is a bony prominence at the anteriormost aspect of the iliac crest, which is palpable in most patients regardless of habitus; it serves as the origin for the sartorius and the medial aspect of the tensor fasciae latae.


  • Iliac crest: The iliac crest is a bony expansion at the superior aspect of the iliac wing extending from the ASIS anteriorly to the posterior superior iliac spine posteriorly and serving as the origin for the internal/external oblique and transversus abdominis muscle groups.


  • Inguinal crease: Overlying the inguinal ligament, a visible crease is present in most patients. The position can be altered by the presence of a large overhanging pannus, which can also cause skin irritation and maceration of the surgical wound. Care should be taken when placing an incision to avoid crossing this area if possible.


  • Pubic symphysis: The pubic tubercle and symphysis pubis can be palpated at the midline medial to the inguinal crease. The symphysis with the bilateral ASIS forms the anterior pelvic plane, which is referenced in some navigated technologies.


  • Greater trochanter: The greater trochanter can be palpated laterally in most patients regardless of habitus and is a common reference for incision placement.


  • Tensor fascia lata: Originating from the ASIS and anterior aspect of the iliac crest, the muscle belly of the tensor fascia lata is typically palpable. Longitudinal incisions should be placed overlying this muscle.


  • Patella: The proximal pole of the patella can be used to estimate leg length, and the lateral border of the patella can also be referenced for incision placement.


Application: Incision Placement (Figure 4.2)







A variety of incision modifications have been described to access the Hueter interval for THA.1,3,5,6,7 Currently, most anterior hip surgeons use a limited longitudinal incision for primary THA, whereas the bikini incision described by Leunig et al5 has been gaining popularity. Dual-incision techniques using the Hueter interval anteriorly have fallen out of favor in recent years.2

Apr 2, 2025 | Posted by in ORTHOPEDIC | Comments Off on Surgical Anatomy of the Anterior Hip and Thigh

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