Technique for Anterior Approach THR

Technique for Anterior Approach THR, arthroscopic view during anterior cruciate ligament reconstruction — Arthroscopic view during anterior cruciate ligament reconstruction. Image by Arthroscopist, Wikimedia Commons, CC BY-SA 4.0.

Position

supine

Landmarks

ASIS
Iliac crest

Incision

Curved longitudinal incision
Runs along the anterior half of the iliac crest to the ASIS
Then vertically down anterior thigh for 8 cm

Internervous Plane

Superficial
- Sartorius
  - Femoral nerve
- Tensor fascia latae
  - Superior gluteal nerve
Deep
- Rectus femoris
  - Femoral nerve
- Gluteus medius
  - Superior gluteal nerve

Superficial Dissection

Deepen the incision
Being careful to avoid damaging the Lateral Femoral cutaneous nerve of the thigh
ER leg to stretch Sartorius to make it more prominent
Identify the gap between TFL & sartorius
- Develop this plane
- Superiorly near the ASIS
  - Ascending Branch of Lateral femoral circumflex artery must be ligated

Deep Dissection

Identify Rectus femoris & Gluteus medius
Detach the Direct & Reflected heads of Rectus from its origins & retract it medially
Retract Gluteus medius laterally
Exposes hip joint capsule
Iliopsoas is often partly attached to inferior aspect of hip joint capsule & must be released from it
Adduct & IR leg to stretch & define capsule
T shaped capsular incision

Dangers

Nerves
- Lateral femoral cutaneous nerve
- Femoral nerve
Vessels
- Ascending branch of lateral femoral circumflex artery

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