A clinical and radiographic study of the “safe area” using the direct lateral approach for total hip arthroplasty

Comstock, Chris; Imrie, Susie; Goodman, Stuart B.

doi:10.1016/0883-5403(94)90100-7

Cited by 29 publications

(19 citation statements)

References 9 publications

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“…Baker and Bitounis (1989) found more positive postoperative Trendelenburg tests after the lateral approach than after the posterior one and considered that this weakness was due to detachment of the gluteal ap, although they did not quantify abductor strength. In addition, violation of the 'safe zone' (Comstock et al 1994) within 5 cm of the greater trochanter may damage the superior gluteal nerve and thus further risk of abductor muscle weakness (Ramesh et al 1996, Baker andBitounis 1989). However, the role of nerve injury in the production of postoperative abductor weakness is not clear as Kenny et al (1999) found that EMG evidence of acute nerve injury does not correlate with the clinical ndings of weak abduction.…”

Section: Discussionmentioning

confidence: 93%

Hip abductor strength following total hip arthroplasty: A prospective comparison of the posterior and lateral approach in 100 patients

Downing¹,

Clark²,

Hutchinson³

et al. 2001

Acta Orthopaedica Scandinavica

126

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We studied the hip abductor strength and Trendelenburg test prospectively in 100 patients undergoing total hip replacement via a lateral or posterior approach. In 49 patients, we used the lateral approach to implant the Charnley total hip replacement, and in 51 patients, the posterior approach to implant the Exeter total hip. Isometric abductor strength was measured with the kinetic communicator device and the Trendelenburg test was recorded preoperatively and at 3 and 12 months postoperatively. Of the original 100 patients, 83 were available for study at 3 months and 73 at 12 months.Hip abductor strength and the Trendelenburg test improved postoperatively in both groups, but we found no difference in hip abductor strength recovery at 3 and 12 months between the lateral approach and the posterior approach. Similarly there was no difference in the Trendelenburg test between the two groups 3 and 12 months following hip replacement. n

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Section: Discussionmentioning

confidence: 93%

Hip abductor strength following total hip arthroplasty: A prospective comparison of the posterior and lateral approach in 100 patients

Downing¹,

Clark²,

Hutchinson³

et al. 2001

Acta Orthopaedica Scandinavica

126

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“…As a result of injury to the superior gluteal nerve, which normally has two branches, the superior and inferior, paralysis of the gluteus medius may occur causing abductor weakness and a positive Trendelenburg's sign. [4][5][6]8,9,11,12 The importance of preventing injury to this nerve has been emphasized. [4][5][6][7][8][9][10][11] Jacobs and Buxton 8 defined the safe area concept for innervations of the gluteus medius muscles to be as much as 5 cm adjacent to the greater trochanter according to measurements of the midpoint of the superior border of the trochanter in 10 cadavers.…”

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confidence: 99%

Reliability of the Safe Area for the Superior Gluteal Nerve

Ekşioğlu

Uslu²,

Güdemez³

et al. 2003

Clinical Orthopaedics &Amp; Related Research

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The authors investigated the reliability of the safe area, which previously was defined to prevent injury to the superior gluteal nerve during the lateral approach to the hip, and its relation to body height. The distance between the point of entry of the superior gluteal nerve into the gluteus medius muscle and the greater trochanter, in the regions which were defined as the anterior and posterior halves of the muscle, were measured in 23 cadaveric hips. There was a significant correlation between the height of the cadavers and the distance in the anterior and posterior regions. In all of the anterior regions and 78% of the posterior regions of the hips, the superior gluteal nerve as found to be in the safe area. The current study showed that the average distance between the innervation point of the gluteus medius muscle and the greater trochanter might change as a function of body height. The risk of damage to the superior gluteal nerve may be higher if the direct lateral approach to the hip is used. These data show that it is possible that the safe area is not always safe.

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“…It has been suggested that a standard "safe area" of at least 5 cm may not be useful in every patient because of differences in body height (Baker and Bitounis 1989, Comstock et al 1994, Eksioglu et al 2003. Eksioglu and coworkers (2003) showed that there was a linear relationship between the heights of cadavers and the distances between the superior gluteal nerve and the tip of the greater trochanter.…”

Section: A B Discussionmentioning

confidence: 99%

Minimally invasive anterolateral approach to the hip: Risk to the superior gluteal nerve

et al. 2007

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A clinical and radiographic study of the “safe area” using the direct lateral approach for total hip arthroplasty

Cited by 29 publications

References 9 publications

Hip abductor strength following total hip arthroplasty: A prospective comparison of the posterior and lateral approach in 100 patients

Hip abductor strength following total hip arthroplasty: A prospective comparison of the posterior and lateral approach in 100 patients

Reliability of the Safe Area for the Superior Gluteal Nerve

Minimally invasive anterolateral approach to the hip: Risk to the superior gluteal nerve

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