Surgically Relevant Bony and Soft Tissue Anatomy of the Proximal Femur

Background: Hip endoscopy facilitates the treatment of extra-articular disorders of the proximal femur. Unfortunately, current knowledge of proximal femur anatomy is limited to qualitative descriptions and lacks surgically relevant landmarks. Purpose: To provide a quantitative and qualitative analysis of proximal femur anatomy in reference to surgically relevant bony landmarks. Study Design: Descriptive laboratory study. Methods: Fourteen cadaveric hemipelvises were dissected. A coordinate measuring device measured dimensions and inter-relationships of the gluteal muscles, hip external rotators, pectineus, iliopsoas, and joint capsule in reference to osseous landmarks. Results: The vastus tubercle, superomedial border of the greater trochanter, and femoral head-neck junction were distinct and reli-able osseous landmarks. The anteroinferior tip of the vastus tubercle was 17.1 mm (95%CI: 14.5, 19.8 mm) anteroinferior to the cen-ter of the gluteusmedius lateral insertional footprint and was 22.9mm (95%CI: 20.1, 25.7mm) inferolateral to the center of the gluteus minimus insertional footprint. The insertions of the piriformis, conjoint tendon of the hip (superior gemellus, obturator internus, and inferior gemellus), and obturator externus were identified relative to the superomedial border of the greater trochanter. The relation-ship of the aforementioned footprints were 49 % (95%CI: 43%, 54%), 42 % (95%CI: 33%, 50%), and 64 % (95%CI: 59%, 69%) from the anterior (0%) to posterior (100%) margins of the superomedial border of the greater trochanter, respectively. The hip joint capsule attached distally on the proximal femur 18.2 mm (95 % CI: 14.2, 22.2 mm) from the head-neck junction medially on average