Symposium on Surface Replacement Arthroplasty of the Hip. Anatomic considerations

Division of the joint capsule close to the level of the acetabular labrum provides the best protection for the essential vessels at the base of the neck and does not jeopardize the acetabular blood supply. The vital medial femoral circumflex artery passes posteriorly, directly below the neck, is afforded little protection by the tenuous inferior capsule, and must get careful consideration during joint exposure, especially if severance of the inferior capsule is contemplated. Low trochanterter osteotomy may injure the principal blood vessels to the superior neck and head. Efforts to stabilize an osteotomized greater trochanter by passing a screw or screws into the inferior neck-shaft junction throw a severe and unnecessary stress on this important weight-bearing region of the proximal femur. Deliberate cutting of the anterior edge of the gluteus minimus from the underlying anterior joint capsule (iliotrochanteric band) facilitates capsular exposure.