Superior gluteal nerve - exits greater sciatic notch 25-40mm proximal to tip of greater trochanter, supplies gluteus medius and minimus, injury causes irreversible abductor weakness and Trendelenburg gait - EXAM KEY: stay within 5cm distal to greater trochanter tip (safe zone), never extend split proximally beyond this
Inferior gluteal nerve - enters gluteus maximus 20-30mm inferior to piriformis, injury rare in lateral approach - EXAM KEY: protected by staying anterior to muscle belly
Femoral nerve - lies 40-60mm anterior/medial to surgical field, at risk with over-aggressive anterior retractor placement - EXAM KEY: anterior retractor should stay on bone (ilium/acetabular rim), never slide medially
Sciatic nerve - runs 30-40mm posterior to hip joint, less at risk than posterior approach but can be injured with posterior retractor - EXAM KEY: posterior retractor should stay on ischium/posterior wall, limit retraction time
Lateral femoral cutaneous nerve - runs 50-70mm anterior/superior to incision, generally safe in direct lateral approach - EXAM KEY: incision centered on GT, not extending too far anterior/superior
Profunda femoris artery with medial/lateral femoral circumflex branches - at risk during vastus lateralis mobilization 40-50mm distal to lesser trochanter - EXAM KEY: subperiosteal dissection along vastus ridge protects vessels
Visual Atlas
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Step-by-Step Technique
1
Use previous incision if midline (most lateral if multiple): EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Skin necrosis from excessive tension
Damage to underlying structures
2
May need tibial tubercle osteotomy or quadriceps snip for exposure: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
3
Remove polyethylene first: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
4
Thin osteotomes to remove components: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
5
Preserve bone stock during extraction: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
6
Remove all cement and fibrous membrane: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
7
Assess bone loss - AORI classification: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
8
Ream femoral and tibial canals for stem extension: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
9
Metal augments for contained defects: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
10
Structural allograft for uncontained defects: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
11
Size femoral component to anterior cortex: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
12
Gap balancing for flexion/extension symmetry: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
13
Constrained insert if collateral deficiency: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
14
Trial and assess tracking, stability, ROM: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
15
Stems with offsets for optimal alignment: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
16
Cement components with antibiotic-loaded cement: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.