Anatomic basis of the transgluteal approach to the hip.

ABSTRACT

In order to define the technical modalities of the so-called transgluteal approach to the hip, the authors studied the structure and topography of the anatomic features encountered in this approach. The gluteus medius, gluteus minimus and vastus lateralis muscles are anatomically continuous by way of their tendinous fibers. The gluteus minimus muscle winds over the cranial and then anterolateral aspect of the capsule, to which it is bound by fibrous tracts and tendinous expansions; its terminal tendon blends its fibers with the anterior part of the tendon of the gluteus medius and enters into continuity with the superficial tendinous fibers of the anterior part of the vastus lateralis. The zone of junction of the three muscle structures is closely bound to the anterior aspect of greater trochanter. The caudal neurovascular trunk of the space between the gluteus medius and vastus lateralis is situated at a distance of 3 to 5 cm from the greater trochanter. The practical surgical implications are discussed, particularly as regards the methods of dissecting the anterior margin of the transgluteal incision, exposure of the capsule and preservation of the neurovascular pedicle, with reference to concepts published previously in studies elsewhere.