title: Minimally invasive medial hip approach.
abstract: The medial approach to the hip via the adductors, as described by Ludloff or Ferguson, provides restricted visualization and incurs a risk of neurovascular lesion. We describe a minimally invasive medial hip approach providing broader exposure of extra- and intra-articular elements in a space free of neurovascular structures. With the lower limb in a "frog-leg" position, the skin incision follows the adductor longus for 6cm and then the aponeurosis is incised. A slide plane between all the adductors and the aponeurosis is easily released by blunt dissection, with no interposed neurovascular elements. This gives access to the lesser trochanter, psoas tendon and inferior sides of the femoral neck and head, anterior wall of the acetabulum and labrum. We report a series of 56 cases, with no major complications: this approach allows treatment of iliopsoas muscle lesions and resection or filling of benign tumors of the cervical region and enables intra-articular surgery (arthrolysis, resection of osteophytes or foreign bodies, labral suture).
authors.affiliation: Service d'orthopédie-traumatologie, institut de l'appareil locomoteur, cinquième étage, hôpital Pierre-Paul-Riquet, 308, avenue de Grande-Bretagne, 31059 Toulouse, France.
authors.forename: P
authors.initials: P
authors.lastname: Chiron
authors.affiliation: Service d'orthopédie-traumatologie, institut de l'appareil locomoteur, cinquième étage, hôpital Pierre-Paul-Riquet, 308, avenue de Grande-Bretagne, 31059 Toulouse, France. Electronic address: murgier.jerome@hotmail.fr.
authors.forename: J
authors.initials: J
authors.lastname: Murgier
authors.affiliation: Service d'orthopédie-traumatologie, institut de l'appareil locomoteur, cinquième étage, hôpital Pierre-Paul-Riquet, 308, avenue de Grande-Bretagne, 31059 Toulouse, France.
authors.forename: E
authors.initials: E
authors.lastname: Cavaignac
authors.affiliation: Service d'orthopédie-traumatologie, institut de l'appareil locomoteur, cinquième étage, hôpital Pierre-Paul-Riquet, 308, avenue de Grande-Bretagne, 31059 Toulouse, France.
authors.forename: R
authors.initials: R
authors.lastname: Pailhé
authors.affiliation: Service d'orthopédie-traumatologie, institut de l'appareil locomoteur, cinquième étage, hôpital Pierre-Paul-Riquet, 308, avenue de Grande-Bretagne, 31059 Toulouse, France.
authors.forename: N
authors.initials: N
authors.lastname: Reina
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D056888:Patient Positioning; D055815:Young Adult
keywords: Adductors; Foreign body; Fracture; Hip approach; Iliopsoas; Minimally invasive surgery; Tumor