Hip – Anterolateral (Watson-Jones)

Intraoperative view of the anterolateral interval, with gluteus medius (blue arrow) posteriorly and tensor fascia lata (green arrow) anterio
Intraoperative view of the anterolateral interval, with gluteus medius (blue arrow) posteriorly and tensor fascia lata (green arrow) anteriorly. Image from Cheong T, Kon Kam King C, Moo IH. Hip hemiarthroplasty through the anterior based muscle sparing approach for femoral neck fractures, an operative technique. Front Surg. 2025, 12, 1673590. CC BY 4.0.
Hip - Anterolateral (Watson-Jones), tensor fasciae latae
Tensor fasciae latae. Image by colorized by Michael Gasperl, Wikimedia Commons, Public domain.

Watson Jones

Position

  • supine
  • buttock over hangs over edge of table
  • tilt table away so patient lies flat
  • prep & drape leg free

Landmarks

  • ASIS
  • Greater trochanter
  • Shaft of femur

Incision

  • Flex the hip 30° & adduct
  • 15cm straight longitudinal incision centred over the tip of the greater trochanter

Internervous Plane

Superficial Dissection

  • Continue the incision through subcutaneous fat down to deep fascia
  • Identify & expose the fascia lata by pushing the fat off using blunt dissection
  • Incise the fascia lata longitudinally in line with its fibres in the direction of the ASIS
  • Exposes underlying Vastus lateralis
  • Identify interval between TFL & gluteus medius using blunt dissection
    • Retract gluteal laterally & proximally to expose joint capsule
  • Fully ER leg to stretch joint capsule
  • Identify the Vastus Lateralis ridge
    • Using diathermy reflect the muscle inferiorly 1 cm

Deep Dissection

  • Detaching the abductor mechanism – if needed
    • 1. Trochanter Osteotomy
      • starting at Vastus Lateralis Ridge
        • straight
        • Chevron
      • Use
        • Gigli saw
        • Osteotome
        • Saw
    • 2. Detaching Gluteus Medius
  • Exposes Hip Joint Capsule

Dangers

  • Nerve
  • Vessels
    • Femoral artery & vein
    • Profunda femoris artery

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