How to avoid injuries of the superior gluteal nerve

Miguel-Pérez, Maribel; Ortiz-Sagristà, J.C.; López‐Lerma, Ingrid; Pérez‐Bellmunt, Albert; Llusá, Manuel; Alex, Lazaro; Combalía, Andrés

doi:10.5301/hip.2010.2761

Cited by 12 publications

(4 citation statements)

References 30 publications

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“…Furthermore, preformed antibiotic-loaded spacers offer off-the-shelf availability, a standardized and reproducible technique, known mechanical resistance [20,21], predictable antibiotic release [22] and shorter operating time [23,24], being available in short and long stemmed shapes [25] that can be chosen intraoperatively based on femoral bone loss.…”

Section: Discussionmentioning

confidence: 99%

Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study

Romanò

Meani

et al. 2011

BMC Infect Dis

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BackgroundOutcome data on two-stage revision surgery for deep infection after septic hip arthritis are limited and inconsistent. This study presents the medium-term results of a new, standardized two-stage arthroplasty with preformed hip spacers and cementless implants in a consecutive series of adult patients with septic arthritis of the hip treated according to a same protocol.MethodsNineteen patients (20 hips) were enrolled in this prospective, non-randomized cohort study between 2000 and 2008. The first stage comprised femoral head resection, debridement, and insertion of a preformed, commercially available, antibiotic-loaded cement hip spacer. After eradication of infection, a cementless total hip arthroplasty was implanted in the second stage. Patients were assessed for infection recurrence, pain (visual analog scale [VAS]) and hip joint function (Harris Hip score).ResultsThe mean time between first diagnosis of infection and revision surgery was 5.8 ± 9.0 months; the average duration of follow up was 56.6 (range, 24 - 104) months; all 20 hips were successfully converted to prosthesis an average 22 ± 5.1 weeks after spacer implantation. Reinfection after total hip joint replacement occurred in 1 patient. The mean VAS pain score improved from 48 (range, 35 - 84) pre-operatively to 18 (range, 0 - 38) prior to spacer removal and to 8 (range, 0 - 15) at the last follow-up assessment after prosthesis implantation. The average Harris Hip score improved from 27.5 before surgery to 61.8 between the two stages to 92.3 at the final follow-up assessment.ConclusionsSatisfactory outcomes can be obtained with two-stage revision hip arthroplasty using preformed spacers and cementless implants for prosthetic hip joint infections of various etiologies.

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Section: Discussionmentioning

confidence: 99%

Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study

Romanò

Meani

et al. 2011

BMC Infect Dis

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“…Hip abductors are innervated from the superior gluteal nerve (SGN) and are important for the stabilization of the trunk in ML directions during gait (especially stance phase), 25 single‐leg standing, 26 and landing 27 . Hip abductor weakness is commonly observed in patients with greater trochanteric pain syndrome, 28 L5 radiculopathy, 29 SGN injury, 30 hip osteoarthritis, 31 and developmental dysplasia of the hip 32 …”

Section: Introductionmentioning

confidence: 99%

“…24 Hip abductors are innervated from the superior gluteal nerve (SGN) and are important for the stabilization of the trunk in ML directions during gait (especially stance phase), 25 single-leg standing, 26 and landing. 27 Hip abductor weakness is commonly observed in patients with greater trochanteric pain syndrome, 28 L5 radiculopathy, 29 SGN injury, 30 hip osteoarthritis, 31 and developmental dysplasia of the hip. 32 The aim of this study was to investigate the effects of an experimentally induced weakness of the gluteal muscles, through sequential nerve blocks of the superior and inferior gluteal nerves, on joint kinematics, reactions forces (JRFs), and dynamic balance performance during deep bilateral squats in healthy young adults.…”

Section: Introductionmentioning

confidence: 99%

The effect of experimentally induced gluteal muscle weakness on joint kinematics, reaction forces, and dynamic balance performance during deep bilateral squats

Dimitriou,

Meisterhans,

Geissmann

et al. 2023

Journal Orthopaedic Research

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Squatting is a common daily activity and fundamental exercise in resistance training and closed kinetic chain programs. The aim of this study was to investigate the effects of an experimentally induced weakness of the gluteal muscles on joint kinematics, reactions forces (JRFs), and dynamic balance performance during deep bilateral squats in healthy young adults. Ten healthy adults received sequential blocks of (1) branch of the superior gluteal nerve to the tensor fasciae latae (SGNtfl) muscle, (2) superior gluteal nerve (SGN), and (3) inferior gluteal nerve (IGN) on the dominant right leg. At the control condition and following each block, the participants were instructed to perform deep bilateral squats standing on two force plates. Hip, knee, ankle, and pelvis kinematics did not differ significantly following iatrogenic weakness of gluteal muscles. The most important finding was the significant differences in JRFs following SGN and IGN block, with the affected hip, patellofemoral, and ankle joint demonstrating lower JRFs, whereas the contralateral joints demonstrated significantly higher JRFs, especially the patellofemoral joint which demonstrated an average maximum difference of 1.43 x body weight compared with the control condition. When performing a deep bilateral leg squat under SGN and IGN block, the subjects demonstrated an increased center of pressure (CoP) range and standard deviation (SD) in mediolateral compared with the control condition. These results imply that squat performance changes significantly following weakness of gluteal muscles and should be considered when assessing and training athletes or patients with these injuries.

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“…The superior gluteal nerve (SGN) is a branch of the sacral plexus that arises from the dorsal divisions of the fourth and fifth lumbar and first sacral ventral rami, and is the only nervous structure to emerge at the gluteal region through the greater sciatic foramen superiorly to the piriformis muscle, in conjunction with the superior gluteal artery and vein [1][2][3][4][5][6][7][8]. The SGN divides into superior and inferior branches: the superior branch innervates the gluteus medius and occasionally the gluteus minimus muscles, the inferior branch innervates the glutei medius and minimus, and ends in the tensor fasciae latae muscle [1][2][3][4][5][6][7][8]. The gluteus medius and minimus, acting from its proximal attachment, abduct the thigh, and their anterior and posterior fibers rotate it medially and laterally, respectively.…”

Section: Introductionmentioning

confidence: 99%

Superior Gluteal Nerve Anatomy and Its Injuries: Aiming for a More Secure Surgical Approach of the Pelvic Region

Pinho,

Leite,

Lixa

et al. 2023

Preprint

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Because most of the recognized causes of superior gluteal nerve (SGN) injury are iatrogenic, detailed knowledge of the anatomy of the SGN is crucial to prevent its injury associated with surgical procedures. This study aims to describe the precise location of SGN or its branches at the greater sciatic foramen, measure the distances of these nervous structures to palpable bony landmarks, and evaluate the possible correlation between these parameters and pelvis size. Twenty human cadaveric hemipelvises were studied. After dissection to expose the SGN or its branches at the greater sciatic foramen, the distances from these nervous structures to the greater trochanter (GT), to the anterior superior iliac spine (ASIS), to the posterior superior iliac spine (PSIS), to the ischial tuberosity (IT), and to the greater sciatic notch were measured. We found that at the greater sciatic foramen the SGN emerges as a common trunk in 75% of hemipelvises, and already divided in its superior and inferior branches in 25% of hemipelvises. When the SGN exits the pelvis as a common trunk, it does so, in most cases, in contact with the bone at the apex of the greater sciatic notch or superior to it. The median distance from the SGN at the greater sciatic notch to the PSIS, ASIS, GT and IT is 7.6 cm, 10.9 cm, 7.5 cm and 10.8 cm, respectively. We found a positive correlation between some of the analyzed parameters and the size of the pelvis. The anatomical data of this study may serve as pivotal guides during orthopedic pelvic surgery, contributing to minimize SNG iatrogenic lesions with significant implications in the patient's quality of life.

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How to avoid injuries of the superior gluteal nerve

Abstract: A 2-3-cm safe area above the greater trochanter is appropriate to prevent nerve damage.

Cited by 12 publications

References 30 publications

Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study

Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study

The effect of experimentally induced gluteal muscle weakness on joint kinematics, reaction forces, and dynamic balance performance during deep bilateral squats

Superior Gluteal Nerve Anatomy and Its Injuries: Aiming for a More Secure Surgical Approach of the Pelvic Region

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