Objective: The aim of this cadaveric study was to quantitatively characterize the spatial relationship between the deep branch of the medial femoral circumflex artery (MFCA) and the obturator externus (OE), quadratus femoris (QF), and obturator internus (OI) tendons, and to define measurable surgical safety distances for posterior hip approaches.
Materials and Methods: Eleven hips from six formalin-fixed adult cadavers without prior hip surgery or major trauma were dissected. Posterior exposure was performed using the Kocher–Langenbeck approach. The deep branch of the MFCA was traced within the QF–OE interval via microdissection. Measurements included the tendon widths of OE and QF, the shortest distance of the deep branch to the OE insertion, the distance of the trochanteric branch to the lower OE and upper QF borders, and the capsular entry point relative to the distal border of the OI conjoint tendon. Distances were measured using a digital caliper with steel pin anatomical references.
Results: The mean widths of the OE and QF tendons were 9.0 mm and 30.0 mm, respectively. The deep MFCA branch coursed at an average of 9.2 mm from the OE insertion. The trochanteric branch was located 7.0 mm from the lower OE border and 5.4 mm from the superior QF border. The capsular penetration site was positioned 3.6 mm distal to the distal OI tendon. The deep branch gave an average of four lateral branches prior to capsular entry.
Conclusion: The close millimetric proximity of the MFCA deep branch to the posterior short external rotators highlights the need for OE preservation, controlled QF retraction, and medially placed, limited-length conjunct tendon incisions to maintain femoral head vascularity during posterior hip surgery.

Surgical dislocation of the hip (SHD) as described by Ganz has proven itself to be a safe and reliable technique to treat pre-arthritis hip pain, providing unrestricted access to both the acetabulum and proximal femur and permitting complex corrections such as femoral head reductions and relative neck lengthening while preserving femoral head vascularity. SHD has been effective for wide range of pathologies spanning femoro-acetabular impingement (FAI), synovial chondromatosis, and hip resurfacing. At the core of SHD is precise knowledge of the extracapsular anatomy of the medial femoral circumflex arteries (MFCA) and its surrounding structures ensuring to avoid iatrogenic avascular necrosis of the femoral head. Despite precise knowledge of the anatomy of the hip and the surgical technique, surgical dislocation has inherent risks. The complications were graded into major, moderate, and minor categories.