Indications:
- Open reduction of DDH (MAOR i.e. Medial Approach Open Reduction)
- Psoas tendon release in hip contractures
- Biopsy and treatment of tumors (inferior portion of femoral neck and medial portion of proximal shaft)
- Obturator neurectomy
Surgical planes:
| Lowa/Iowa/Weinstein-Ponseti (Anteromedial) | Ludloff (Anteromedial) | Ferguson (Posteromedial) | |
| Developed in | 1979 | 1908 | 1973 |
| Superficial interval | Between sartorius (anterior) and adductor longus (posterior) | Between sartorius (anterior) and adductor longus (posterior) | Between adductor longus (anterior) and gracilis (posterior) |
| Deep interval | Between femoral neurovascular bundle (anterior) and pectineus (posterior) | Between pectineus (anterior) and adductor brevis (posterior) | Between adductor brevis (anterior) and adductor magnus (posterior) |
| Benefits | 1. Safest neurovascular visualization 2. Lower reported long-term AVN rates in DDH | 1. Most direct route 2. Minimal soft tissue dissection | 1. Excellent access to inferior/posterior neck and lesser trochanter 2. Moves away from the anterior femoral neurovascular bundle |
| Risks and Disadvantages | Direct proximity to anterior femoral neurovascular bundle | High risk of MFCA damage | High risk of obturator nerve injury |
References:
- Weinstein SL. Operative technique for anteromedial approach to reduction for developmental dysplasia of the hip. Operative techniques in orthopaedics. 1993;3(2):134-40.
- Ludloff K. Zur blutigen Einrenkung der angeborrenen Huftluxation. Zeischr Orthop Chir.. 1908;22:272-6.
- FERGUSON AB. Primary open reduction of congenital dislocation of the hip using a median adductor approach. Journal of Bone and Joint Surgery. 1973 Jun;55(4):671-89.
He is the section editor of Orthopedics in Epomedicine. He searches for and share simpler ways to make complicated medical topics simple. He also loves writing poetry, listening and playing music. He is currently pursuing Fellowship in Hip, Pelvi-acetabulum and Arthroplasty at B&B Hospital.
