Post Hip Approach (Moore or Southern)

Question 1

superficial dissection

Answer 1

• Incise fascia lata to uncover vastus lateralis distally

- Split fibers of gluteus maximus in proximal incision (inf gluteal nerve, inf and sup gluteal art).

Question 2

Deep dissection

Answer 2

• Internally rotate the hip (stretch short external rotators)
• Stay suture in piriformis and obturator internus tendon
• Detach both close to femoral insertion
• reflect to protect sciatic nerve medially

Question 3

Dangers

Answer 3

1. Inf gluteal artery - leave below piriformis
2. First perforating branch of profunda femoris
3. Femoral vessels - failure to protect ant aspect of acetabulum with placement of retractors ant to iliopsoas
4. Sup gluteal art and nerve - leave above piriformis
5. Quadratus femoris - excessive retraction could damage medial circumflex artery

Question 4

Piriformis

Answer 4

Origin: ant surface of lateral process of sacrum and gluteal surface of ilium at margin of greater sciatic notch
Insertion: sup border of GT
Action: lat rotator, abduct if hip is flexed
Innervation: Piriformis (L5,S1-2)
Arterial supply: sup/inf gluteal and internal pudendal arteries

Question 5

Obturator Internus

Answer 5

Origin: internal surface of obturator membrane and post bony margins of obturator foramen
Insertion: Medial surface of GT
Action: rotate thigh laterally, abduct if thigh flexed
Innervation: N to obturator internus and sup gemellus - branch of sacral plexus (L5, S1)
Arterial supply: internal pudendal and sup/inf gluteal

Question 6

Sup Gamellus

Answer 6

Origin: ischial spine
Insertion: medial surface of GT of femur
Action same as others
Innervation: N to obturator internus and sup gemellus (L5,S1)
Artery: inf gluteal artery

Question 7

Inf Gemellus

Answer 7

Origin: Post portions of ischial tuberosity and lateral obturator ring
Insertion: medial surface of GT
Innervation: N to quadratus femoris
Arterial Supply: inf gluteal artery

Question 8

Quadratus Femoris

Answer 8

Origin: Lateral margin of obturator ring above ischial tuberosity
Insertion: Quadrate tubercle and adjacent bone of intertrochanteric crest of prox post femur
Innervation: Quadratus femoris branch of n to the quadratus femoris and inferior gemellus (L5,S1)
Arterial supply: medial circumflex femoral artery, inf gluteal arter, 1-4th perforating arteries, obturator artery, and some sup muscular branches of popliteal artery.