Anterolateral Approach to Hip (Watson-Jones)

Indications

Hip - Anterolateral (Watson-Jones), tensor fasciae latae
Tensor fasciae latae. Image by colorized by Michael Gasperl, Wikimedia Commons, Public domain.
  • Uses the interval between TFL and gluteus medius
  • Basis of several minimally invasive anterolateral arthroplasty approaches
  • Total hip replacement and hemiarthroplasty
  • ORIF of femoral neck fractures
  • Synovial biopsy and access to the anterior capsule

Position

  • Supine with a bolster under the buttock, or lateral decubitus
  • Ipsilateral buttock at the table edge falls away from the field

Landmarks and Incision

  • Palpate the ASIS and greater trochanter
  • Starts distal and lateral to the ASIS, passes over the anterior trochanter and runs down the shaft

Internervous Plane

  • No true internervous plane
  • TFL and gluteus medius are both supplied by the superior gluteal nerve
  • The nerve enters TFL deep and posteriorly, so the plane is safe distal to its entry

Superficial Dissection

  • Fascia lata incised posterior to TFL
  • Interval between TFL anteriorly and gluteus medius posteriorly developed bluntly
  • Gluteus medius retracted posteriorly to expose the capsule and gluteus minimus

Deep Dissection

  • Fat over the anterior capsule cleared, reflected head of rectus femoris may be released
  • Partial release of anterior medius and minimus fibres, or trochanteric osteotomy, improves exposure
  • Capsule incised in a T or H shape, or excised
  • Anterior dislocation with external rotation, extension and adduction

Structures at Risk

  • Inferior branch of the superior gluteal nerve to TFL, with proximal dissection of the interval
  • Femoral nerve, artery and vein from anterior acetabular retractors and medial dissection
  • Ascending branch of the lateral femoral circumflex artery, crossing the interval and needing ligation
  • Abductors damaged by retraction or partial release, causing limp

Extension

  • Distal extension by splitting or elevating vastus lateralis to expose the shaft
  • Proximal extension limited by the superior gluteal nerve
  • Röttinger (OCM) variant uses the same interval through a shorter lateral incision
  • OCM preserves the abductors entirely

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.