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.