Treatment of Hip Flexion Contractures with Psoas Recession Through the Middle Window of the Ilioinguinal Approach.

INTRODUCTION: The ilioinguinal approach for psoas recession over the pelvic brim allows for direct visualization and protection of the femoral nerve while preserving hip flexion strength. STEP 1 PATIENT POSITIONING PREOPERATIVE ASSESSMENT AND DRAPING: With the patient supine and anesthetized, perform the Thomas test, administer antibiotics, and drape to provide access to the inferior aspect of the abdomen, ilioinguinal region, and lower limb. STEP 2 SUPERFICIAL DISSECTION: Mark the osseous landmarks, draw a line connecting the anterior superior iliac spine to the pubic tubercle, and make a bikini incision along this line. STEP 3 DEEP DISSECTION: Incise the external oblique aponeurosis and internal oblique and transverse abdominal muscles from the anterior superior iliac spine to the pubic tubercle, leaving a 2-mm cuff of tissue. STEP 4 PSOAS RECESSION: After protecting the femoral nerve, confirm the identity of the psoas with 3 tests and transect it with cautery. STEP 5 POSTOPERATIVE MANAGEMENT: Physical therapy is initiated immediately and includes static and dynamic hip extension exercises that stretch the anterior hips structures.
RESULTS: Hip flexion contracture is a debilitating condition that affects many patients with spastic paresis or prior hip trauma.