Authors of section

Authors

Derek Donegan, Michael Huo, Michael Leslie

Executive editor

Michael Baumgaertner

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Iliofemoral approach (Smith-Petersen)

1. Preliminary remarks

The anterior approach (Iliofemoral or Smith-Petersen) provides the most direct access to the anterior aspect of the hip.

Scar tissue due to previous exposure might obscure typical landmarks.

The anterior approach (Iliofemoral or Smith-Petersen) provides the most direct access to the anterior aspect of the hip. The anterior approach is not commonly used for periprosthetic fractures of the acetabulum.

Skin incision for hip anterior (Iliofemoral or Smith-Petersen) approach

2. Skin incision

The skin incision begins over the lateral iliac crest and follows it to the anterior superior iliac spine. There it turns distally to follow the lateral side of the sartorius muscle.

The skin incision for anterior approach begins over the lateral iliac crest and follows it to the anterior superior iliac spine

3. Develop interval between tensor fascia lata and sartorius

Release the abductor muscles from the lateral iliac crest and deepen the incision anteriorly, along the lateral border of sartorius.
Separate bluntly the tensor fasciae latae from the sartorius.

Release the abductor muscles from the lateral iliac crest and deepen the incision anteriorly, along the lateral border of ...

4. Deep surgical dissection

Identify, divide and ligate the lateral femoral circumflex vessels distally. Release the direct head of rectus femoris from the anterior inferior iliac spine, either through the tendon, or with an osteotomy.
Release the reflected head of this muscle from its more lateral attachment proximal to the hip capsule. This should be performed if more proximal exposure is needed.

Identify, divide and ligate the lateral femoral circumflex vessels distally. Release the direct head of rectus femoris...

If necessary, fully release the indirect and direct head of rectus femoris for improved exposure.

If necessary, fully release the indirect and direct head of rectus femoris

A T-shaped incision, with retention sutures medially and laterally, allows exposure of the proximal femur and prosthesis.

Lateral traction and repositioning (abduction and external rotation) the leg improves access to the bony pathology.

A T-shaped incision, with retention sutures medially and laterally, allows exposure of the femoral head and neck

5. Closure

The closure includes:

  • Capsular repair
  • Rectus femoris reattachment if released
  • Abductor origin repair

Considerations for periprosthetic fracture patients

A layered closure is preferred for periprosthetic fractures. A subfascial drain should be considered as blood loss can be significant and periprosthetic fracture patients are at high risk of requiring anticoagulation immediately postoperatively. A hematoma requiring evacuation must be avoided. The wound is closed in layered fashion according to the surgeon's preference.

Sterile dressing should be applied, and negative pressure incisional wound care can be considered.

Negative pressure incisional wound care