Conservative Hip Surgery

Kenanidis, Eustathios; Tsiridis, Eleftherios; Leunig, Michael; Ganz, Reinhold; Aprato, Alessandro; Massè, Alessandro; Spiker, Andrea M.; Rotter, Ben-Zion; Poultsides, Lazaros; Kelly, Bryan T.; Desy, Nicholas M.; Sierra, Rafael J.; Jakobsen, Stig Storgaard; Søballé, Kjeld

doi:10.1007/978-3-319-64177-5_1

Cited by 2 publications

(1 citation statement)

References 37 publications

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“…The first “ischial” cut is one of the most demanding steps because it has to be executed without direct visual control and it is quite close to the sciatic nerve in an adult hip. Pioneers of this surgical procedure advocate extension of the hip during this cut to bring the sciatic nerve more laterally [ 2 , 8 ]. However, one recent MR study reported the greatest distances of the sciatic nerve to infracotyloid groove at hip flexion/abduction/external rotation (20 mm) compared to neutral (14.8 mm) and flexion (11.8 mm) groups in healthy children.…”

Section: Discussionmentioning

confidence: 99%

A CT study of the femoral and sciatic nerve periacetabular moving in different hip positions

Işın¹,

Hapa

Kara

et al. 2020

J Orthop Surg Res

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Background Femoral and sciatic nerves could be damaged during various stages of the periacetabular osteotomy. Changing the position of the hip could be the most effective way of preventing nerve injuries. The purpose of the present study was to investigate the distances of the nerves to various bony landmarks with different hip positions in computerized pelvic scanograms of healthy adults. Materials and methods Fifteen healthy male adults (30 hips) (age 30 ± 6) were included. Scans were performed at three different hip positions measured by goniometer (neutral “N,” flexion (30–45°) + abduction (30–45°) + external rotation (20°) “F” and neutral+ abduction (30–45°) + external rotation (20°) (Nabext) at three different levels (sourcil “1,” the middle of the femoral head “2,” and lower border of triradiate cartilage “3.” Results At the sourcil level, the femoral nerve was found to be the furthest distance from the anterior acetabulum in the neutral position compared to flexion or neutral plus abduction, external rotation (p < 0.001). For the sciatic nerve, at level 2, hip flexion resulted in a greater distance than in the neutral position (p = 0.001). For level 3, hip flexion caused a decrease in the distance of the sciatic nerve to the acetabulum compared to both neutral positions (N or Nabex) (p = 0.001). Conclusions During a pubic cut of the osteotomy, the femoral nerve moves closer to the anterior acetabulum wall with hip flexion or abduction plus external rotation. During an ischial cut, the sciatic nerve gets closer to the ischium with hip flexion while it moves away from the bone during retroacetabular cut. Level-III Study

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Section: Discussionmentioning

confidence: 99%

A CT study of the femoral and sciatic nerve periacetabular moving in different hip positions

Işın¹,

Hapa

Kara

et al. 2020

J Orthop Surg Res

View full text Add to dashboard Cite

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Bony landmarks, distances and their correlations to each other, which can be used during periacetabular osteotomy: a CT study performed on dysplastic hips

Hapa

Gürsan

Eroğlu

et al. 2021

Journal of Hip Preservation Surgery

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As a surgical technique for hip dysplasia, Bernese periacetabular osteotomy (PAO) still poses technical difficulties and unclear surgical steps like the depth of the first ‘ischial’ cut, the start of the iliac cut and the width of the retroacetabular cut to prevent either iatrogenic joint entrance or posterior column fracture. Twenty-seven dysplastic hips (CE < 25°) were randomly matched with nondysplastic hips (n: 27, CE > 25°). 3D CT sections of the hips were evaluated and the width of the ischium, the distance from the infra-acetabular groove to the ischial spine, from the anterior superior iliac spine (ASIS) to the joint or sciatic notch or the sciatic spine, from the most medial point at the acetabulum to the posterior column, ischial spine or sciatic notch were measured for each group and correlated. The distances (mm) from the infra-acetabular groove to the ischial spine (42 ± 4, 44 ± 4, P: 0.03), the anterior superior iliac spine to the joint (52 ± 6, 60 ± 3, P: 0.03), the most medial point at the acetabulum to the posterior column (34 ± 2, 36 ± 2, P: 0.005) were shorter in the dysplastic group. The distance from the ASIS to the sciatic notch was correlated with the distance from the infra-acetabular groove to the ischial spine, from the ASIS to the joint and the most medial point at the acetabulum to the posterior column. The distance from the ASIS to the sciatic notch can be used intraoperatively to guess the X-ray guided or blindly osteotomized stages to predict the width or depth of the osteotomy to prevent intraarticular extension or posterior column fracture.

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Conservative Hip Surgery

Cited by 2 publications

References 37 publications

A CT study of the femoral and sciatic nerve periacetabular moving in different hip positions

A CT study of the femoral and sciatic nerve periacetabular moving in different hip positions

Bony landmarks, distances and their correlations to each other, which can be used during periacetabular osteotomy: a CT study performed on dysplastic hips

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