Injury to the superior gluteal artery as a complication of total hip-replacement arthroplasty. A case report.

Lozman, Harvey; Robbins, Hilary

doi:10.2106/00004623-198365020-00022

Cited by 37 publications

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“…The gluteus medius and minimus are raised in two separate flaps from the greater trochanter, and retraction of both these tendons superiorly usually requires the use of Charnley acetabular pin retractors driven into the pelvis above the superior acetabular margin. This can lead to injury to the superior gluteal artery, with consequent retroperitoneal hemorrhage, particularly if the pin is driven more than 4 cm into the ileum (Lozeman and Robbins 1983). Hanssen (1991) places the patient in the lateral decubitus position, which may lead to difficulties in the orientation of the implants and in the correction of discrepancies in the leg lengths, particularly for surgeons who are accustomed to operating on patients in the supine position.…”

Section: Discussionmentioning

confidence: 99%

An anterolateral approach to the hip joint

Soni¹

1997

Acta Orthopaedica Scandinavica

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I describe an anterolateral approach to the hip joint. The intermuscular plane is between the gluteus medius and tensor fascia lata. The anterior one third of gluteus medius and the insertion of gluteus minimus are stripped from the anterior aspect of the greater trochanter to raise a flap in a way that facilitates reattachment. The vastus lateralis muscle is left undisturbed. This simple and relatively quick approach provides sufficient anatomic orientation and exposure to allow the surgeon to perform total hip arthroplasty, with minimal dissection and without excessive retraction. There is no danger of injury to the superior gluteal nerve or its branches. This has been used in 178 patients for primary total hip replacement. The strength of the hip abductor muscles was unimpaired and there were no complications attributable to the approach in 128 patients reviewed after at least 6 months.

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Section: Discussionmentioning

confidence: 99%

An anterolateral approach to the hip joint

Soni¹

1997

Acta Orthopaedica Scandinavica

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“…Thirty of these were thought to be cement related, 12 caused by retractor trauma, seven as a result of excessive traction, and five the result of intrapelvic migration of the acetabular component. The remainder were causcd by reaming (2) or osteotome (1) trauma, or were of unknown cause (11). Fortythree percent of the injuries required emergent vascular surgical intervention.…”

Section: Literature Reviewmentioning

confidence: 99%

The management of vascular injuries associated with total hip arthroplasty

Shoenfeld¹,

Stuchin²,

Pearl³

et al. 1990

Journal of Vascular Surgery

143

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Approximately 100,000 total hip reconstructions are done annually in the United States. The nature of the surgical technique in a field close to the iliac and femoral vessels makes the occurrence of vascular injury an occasional but serious complications. We have reviewed retrospectively our experience of five cases of vascular injuries with total hip replacement and an additional 63 cases in the literature to identify those patients at risk and to define the management of these injuries. For the entire group of 68 patients, most injuries were sustained on the left side (66%), and 39% were seen in revisions. Complications were related to cement incorporation of the iliac vessels (44%), aggressive medial retraction (17%), excessive traction on atherosclerotic vessels (10%), and improper technique in preparation of the acetabulum. The most commonly injured vessels were the external iliac artery (36), common femoral artery (17), and external iliac vein (6). Twenty-seven of these injuries required emergent surgery, most for hemorrhage (66%). Injuries consisted of thromboembolic complications leading to distal ischemia (46%), vessel lacerations (26%), pseudoaneurysms (25%), and arteriovenous fistulas (3%). Vascular repair was individualized and included suture repair, thrombectomy and patch angioplasty, embolectomy, and arterial and venous bypass procedures. There was an overall 7% mortality and a 15% incidence of limb loss. Risk factors include (1) revision procedures, (2) left-sided procedures, and (3) intrapelvic migration of the acetabular component of the hip prosthesis. Elective vascular workup and preliminary retroperitoneal exposure of the iliac vessels at time of hip arthroplasty is recommended for patients at risk.

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“…Injury to the superior gluteal nerve (SGN) can lead to gluteal dysfunction, a Trendelenberg gait and a poor outcome following surgery. Subclinical SGN injury following primary total hip arthroplasty is common and has been documented to occur during many different surgical approaches to the hip (1, 3–4–5–6–7–8–9). In one study it was as high as 77% regardless of whether a posterior or lateral approach was used with a persistent limp in over 50% of patients at 6 months (5).…”

Section: Introductionmentioning

confidence: 99%

Exposure of the Superior Gluteal Neurovascular Bundle for the Safe Application of Acetabular Reinforcement Cages in Complex Revisions

et al. 2016

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The posterior approach to the hip is the most common extensile approach used, however exposure is limited superiorly by the superior gluteal neurovascular bundle (SGNB). The extra-pelvic course of the SGNB demonstrates variability between individuals, occasionally located only 1 cm from the acetabular rim. In complex acetabular reconstructions where the application of a reinforcement cage maybe required protecting the SGNB is challenging. The flanges of these cages are designed to sit on the ilium superior to the acetabular rim and to receive screws for fixation. The application of such cages may result in iatrogenic injury to the SGNB by way of forceful retraction or entrapment. We describe a technique that involves exposure and release of the SGNB such that the flanges of cage constructs may be safely applied.

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Injury to the superior gluteal artery as a complication of total hip-replacement arthroplasty. A case report.

Cited by 37 publications

References 0 publications

An anterolateral approach to the hip joint

An anterolateral approach to the hip joint

The management of vascular injuries associated with total hip arthroplasty

Exposure of the Superior Gluteal Neurovascular Bundle for the Safe Application of Acetabular Reinforcement Cages in Complex Revisions

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