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The anterior Smith-Peterson approach to the hip uses a surgical plane between which of the following superficial muscles?
Gluteus maximus and tensor fascia lata
Gluteus medius and tensor fascia lata
Sartorious and adductor longus
Rectus femoris and adductor longus
Sartorious and tensor fascia lata
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The anterior Smith-Peterson approach to the hip uses an inter-nervous plane dissecting between sartorious and tensor fascia lata innervated by the femoral and superior gluteal nerves. Superficially, the plane is identified between the sartorius (femoral nerve) and tensor fascia lata (superior gluteal nerve) (Illustration A). Deep, the plane is between the rectus femoris (femoral nerve) and gluteus medius (superior gluteal nerve) (Illustration B). Anterior minimally invasive hip arthroplasty is now being performed using this approach.
Meneghini et al compared the anterior and posterior approaches to the hip in six human cadavers. They graded the amount of muscle damage and compared the specific muscles damaged using both approaches. Interestingly, they found that the piriformis or conjoined tendons were transected in 50% of the anterior approaches to the hip - suggesting that the anterior approach might not be as "minimally invasive" as previously believed.
Meneghini RM, Pagnano MW, Trousdale RT, Hozack WJ
Clin. Orthop. Relat. Res.. 2006 Dec;453:293-8. PMID: 17006366 (Link to Abstract)
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What two nerves make up the internervous plane in the Smith-Petersen anterior hip approach?
There is no internervous plane
Femoral nerve and inferior gluteal nerve
Femoral nerve and superior gluteal nerve
Obturator nerve and superior gluteal nerve
Obturator nerve and inferior gluteal nerve
The internervous plane in the Smith-Petersen anterior hip approach is made by the femoral nerve and superior gluteal nerve.
The anterior Smith-Petersen hip approach uses the superficial internervous plane between the sartorius (femoral nerve) and the tensor fascia latae (superior gluteal nerve). The deep plane for access to the hip joint capsule uses the same internervous plane but is between the rectus femoris (femoral nerve) and the gluteus medius (superior gluteal nerve). In this approach to the hip, one must be conscious to avoid damaging the lateral femoral cutaneous nerve.
Illustration A and B show the superficial and deep internervous plane.
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The ascending branch of the lateral femoral circumflex artery is at risk with which of the following surgical approaches?
The ascending branch of the lateral femoral circumflex artery is at risk during the Smith-Petersen approach to the hip. In this approach, an internervous interval between the femoral nerve (sartorius, superficial; rectus femoris, deep) and superior gluteal nerve (tensor fascia latae, superficial; gluteus medius, deep) is utilized.
The ascending branch of the lateral femoral circumflex artery runs proximally in the internervous plane between the two deep muscles.
Answer 1: http://www.orthobullets.com/approaches/12056/stoppa-approach-to-acetabulum
Answer 2: http://www.orthobullets.com/approaches/12015/posterior-approach-to-the-acetabulum-kocher-langenbeck
Answer 3: http://www.orthobullets.com/approaches/12016/ilioinguinal-approach-to-the-acetabulum
Answer 4: http://www.orthobullets.com/approaches/12021/hip-anterolateral-approach-watson-jones
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This is a video of the Smith-Peterson approach to the hip.
Ajoy Jana, MD, has been using an innovative surgical technique for hip replaceme...
A detailed run though with narration of a total hip arthroplasty performed throu...