Medial approach to the Hip joint

Ludloff

Position

supine
hip flexed, abducted & externally rotated
sole of foot on affected side should lie along medial side of contralateral knee

Landmarks

adductor longus
pubic tubercle

Incision

Longitudinal incision on the medial side of side centred over adductor longus
Start: 3cm below pubic tubercle
End: length determined by amount of femur needed to be exposed

Internervous Plane

Superficial
- Adductor longus
  - Anterior division of obturator
- Gracilis
  - Anterior division of obturator
Deep
- Adductor brevis
  - Anterior division of obturator
- Adductor magnus
  - 2 nerve supplies
    - adductor portion
      - posterior division of obturator
    - ischial portion
      - tibial part of sciatic nerve

Dissection

develop plane between gracilis & adductor longus using blunt dissection
identify & protect the anterior division of the obturator nerve
identify & develop the plane between adductor brevis & magnus
exposes lesser trochanter
identify & protect posterior division of obturator nerve

Dangers

Nerves
- Anterior division of obturator
  - lies on top of obturator ext. & runs down med. side of thigh between add. longus & add. Brevis
  - supplies add. longus, gracilis, add. brevis
- Posterior division of obturator
  - lies in substance of obturator ext. & runs down thigh on add. magnus & under add. brevis
  - supplies obturator ext. & add. portion of add. magnus
Vessels
- med. fem. circumflex art.
  - passes around med. side of distal part of psoas