FIGURE 7.1. Various descriptions of an anterior portal have been proposed: (A) based lateral to the femoral pulse; (B) 1 cm lateral and distal to the midpoint of a line between the anterior superior iliac spine (ASIS) and symphysis pubis; (C) site of intersection of a sagittal line from the ASIS and a transverse line from the symphysis pubis; (D) midpoint of a line between the ASIS and superior tip of the greater trochanter; (E) intersection of a sagittal line from the ASIS and a transverse line from the tip of the greater trochanter. Note: I strongly discourage consideration of the portal described in B; this does not appear to represent a safe approach to the joint. Also, note that palpation of the femoral pulse as a landmark can be difficult once the surgical field has been sterilely prepared.
FIGURE 7.2. The site of the anterior portal coincides with the intersection of a sagittal line drawn distally from the anterior superior iliac spine and a transverse line across the superior margin of the greater trochanter. The direction of this portal courses approximately 45 degrees cephalad and 30 degrees toward the midline. The anterolateral and posterolateral portals are positioned directly over the superior aspect of the trochanter at its anterior and posterior borders. (Courtesy of Smith & Nephew Endoscopy, Andover, MA.)
Although variable in its relationship, the ascending branch of the lateral circumflex femoral artery is usually approximately 3.7 cm inferior to the anterior portal (Figure 7.6). In some cadaver specimens, a small terminal branch of this vessel has been identified lying within millimeters of the portal at the level of the capsule. The clinical significance of this is uncertain, and there have been no reported cases of excessive bleeding from the anterior position.
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