Treatment of Hip Flexion Contractures with Psoas Recession Through the Middle Window of the Ilioinguinal Approach.

ABSTRACT

INTRODUCTION: The ilioinguinal approach for psoas recession over the pelvic brim allows for direct visualization and protection of the femoral nerve while preserving hip flexion strength. STEP 1 PATIENT POSITIONING PREOPERATIVE ASSESSMENT AND DRAPING With the patient supine and anesthetized, perform the Thomas test, administer antibiotics, and drape to provide access to the inferior aspect of the abdomen, ilioinguinal region, and lower limb. STEP 2 SUPERFICIAL DISSECTION Mark the osseous landmarks, draw a line connecting the anterior superior iliac spine to the pubic tubercle, and make a bikini incision along this line. STEP 3 DEEP DISSECTION Incise the external oblique aponeurosis and internal oblique and transverse abdominal muscles from the anterior superior iliac spine to the pubic tubercle, leaving a 2-mm cuff of tissue. STEP 4 PSOAS RECESSION After protecting the femoral nerve, confirm the identity of the psoas with 3 tests and transect it with cautery. STEP 5 POSTOPERATIVE MANAGEMENT Physical therapy is initiated immediately and includes static and dynamic hip extension exercises that stretch the anterior hips structures. RESULTS: Hip flexion contracture is a debilitating condition that affects many patients with spastic paresis or prior hip trauma.