Anterior hip anatomy for the open hip preservation surgeon

<h2>ABSTRACT</h2><h3>Introduction</h3> Supine, anterior-based hip surgery has been popularized over the last few decades, not just for arthroplasty but also for hip preservation indications. Hip surgeons have employed anterior approaches to safely perform periacetabular osteotomy (PAO), femoral osteochondroplasty, and open reduction of femoral neck fractures while minimizing the risk of disrupting blood supply to the femoral head, often in a muscle-sparing manner. <h3>Objectives</h3> The objectives are to describe and provide insight into anterior-based surgical hip anatomy and its relevance to open hip preservation surgery. We aim to use cadaveric dissections to demonstrate relevant surgical relationships and provide anatomically helpful tips and tricks. <h3>Methods</h3> Cadaveric dissections of anterior-based hip structures were performed and the relevant literature reviewed to give surgically relevant anatomic relationships. <h3>Results</h3> We present the anatomic relationships relevant to open anterior hip preservation surgery. These are illustrated with cadaveric dissections and a discussion of the relevant literature highlighting the current understanding of how open hip anatomy affects operative planning and execution. Additionally, technical pearls and pitfalls are presented throughout in order to highlight relevant anatomical concepts and better illustrate how to effectively obtain safe and satisfactory surgical exposure at the time of open anterior hip preservation surgery. <h3>Conclusions</h3> Hip preservation surgery remains technically challenging with a steep learning curve, but with a thorough understanding of the relevant anatomy, safe and effective procedures can be carried out for the benefit of patients.