Table 5.

Surgical Approaches for Heterotopic Ossification Removal about the Hip¹⁶

	Landmarks and Positioning	Incision	Superficial and Deep layers	Dangers
Smith-Petersen	ASIS Iliac crest Greater trochanter Positioning: Supine	Begin at the inferior aspect of the iliac crest, just below the ASIS. Continue distally about 10cm.	Superficial: Between the sartorius muscle and TFL Deep: Between the rectus femoris and the gluteus medius muscles	Nerves: •LFCN, usually 1-3 cm medial to the ASIS •Femoral nerve may be damaged from retraction or direct injury. Stay lateral to the sartorious muscle to avoid injury. Vessels: •Ascending branch of the lateral femoral circumflex artery is ligated during the approach •Femoral artery and vein can be damaged by too much retraction
Modified Gibson	Great trochanter Iliac crest Shaft of the proximal femur Positioning: Lateral	Begins midlateral on the thigh, extending 20-30 cm toward the tip of the greater trochanter, then proximally to the level of the iliac crest, in a straight incision	Superficial: TFL Deep: Gluteus maximus, abductors	Nerves •Sciatic nerve injury from direct injury, retraction, or repair of the adductors •Femoral nerve injury from retraction or displacement of the proximal femur •Obturator nerve injury from electrocautery or retraction Vessels •Inferior gluteal artery injury during retraction •Medial femoral circumflex artery injury during takedown of the adductors •Obturator artery injury during retraction

ASIS, anterior superior iliac spine; LFCN, lateral femoral cutaneous nerve; TFL, tensor fasciae latae.