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By Kurosh A.G.

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Using a periosteal elevator, the capsule is then lifted along a line from the insertion of the rectus femoris to the tubercle of the vastus lateralis, with the limb held in slight rotation and flexion without constraint. Arthrotomy The arthrotomy is performed at the superior edge of the neck, from the insertion of the rectus femoris to the tubercle of the vastus lateralis (Fig. 5). An initial debridement is performed at the base of the neck towards the lesser trochanter along the inter-trochanteric line to free the large anterior capsular flap, which is preserved.

The superior aspect of the rectus muscle is identified. There is usually a layer of fat in this region that covers the lateral aspect of the rectus and lies on top of the capsule. This fat is excised. At this point, the anterior portion of the capsule should be seen with the rectus muscle medially, the tendon of the reflected head cranially, and the fibers of the 5 Anterior Approach for Total Hip Arthroplasty: Technique Without Fracture Table 57 a b 2 cm 2 cm 8–12 cm Fig. 2 (a) The patient is supine on regular OR table.

5 Anterior Approach for Total Hip Arthroplasty: Technique Without Fracture Table 55 1 2 3 4 5 6 Fig. 1 The Smith-Petersen or Hueter approach uses the interval between the TFL (4) and the sartorius (1). The TFL (4) and the abductors, gluteus minimus (5), and gluteus medius (6) are retracted laterally and the sartorius (1), rectus femoris (3), and iliopsoas (2) are all retracted medially to expose the capsule (Figure Courtesy of ICON) Patients and Methods Patients During the calendar year of 2007, from January through December, 141 total hip replacements were performed in 128 patients.

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