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The anteromedial approach to the hip in adults

On 12/11/2018
Article viewed 140 times

The anteromedial approach to the hip in adults

By Philippe Chiron, Jérôme Murgier in category TECHNIQUE
Département Orthopédie Traumatologie - CHU Toulouse - France

Medial approaches to the hip are mainly used in pre-walking children in developmental dysplasia of the hip.

Introduction

Medial approaches to the hip are mainly used in pre-walking children in developmental dysplasia of the hip.

In adults, the Ludloff approach (1) that runs between the pectineus muscle in front and the adductor longus and brevis muscles at the back, and the Ferguson approach (2), which runs more posteriorly between the adductor brevis muscle and the pectineus muscle in front and the adductor longus muscle at the back[A1] , offer only a narrow view of the inferior femoral neck and head, by not allowing dissection of the tendon of the psoas muscle and by entailing a risk of damage to the obturator nerve, especially the posterior branch. The so-called Iowa approach (3) passes in front of the adductor muscles but has never been described in adults. As a result of an anatomical study and our surgical practice, we propose herein an adaptation to these medial routes for surgery in adults and set out indications (4) (Fig. 1).

Figure 1: Ludloff, Ferguson, Iowa and Chiron approaches.

 

Chapter 1 - Operating technique

Patient positioning

The patient is positioned in dorsal decubitus. The limb to be operated on is positioned with the hip flexed, externally rotated and abducted, also known as the Frog Leg position. In this position, the adductor longus muscle becomes prominent...

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