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

Ince, Akif; Kemper, M; Waschke, Jens; Hendrich, Christian

doi:10.1080/17453670610013466

Cited by 51 publications

(27 citation statements)

References 13 publications

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“…We could not confirm the potential risks of the approach described in the literature, such as injury to the superior gluteal nerve, compression, and dissection injuries caused by retractors and rasps [17,31,50]. In contrast, the comparative group with the mDL approach showed a higher postoperative fatty atrophy of the gluteus medius, particularly of the anterior part.…”

Section: Discussionmentioning

confidence: 86%

“…We saw a higher-grade degeneration of the gluteus medius in the mDL approach group in connection with surgery-related denervation of the anterior part of the muscle [17,40]. The incision can cause damage to the lower branches of the superior gluteal nerve, which runs between the gluteus medius and minimus, while a lack of reintegration of the gluteal tendon accompanied by atrophy is also possible [13,17]. The postoperative changes to the gluteus medius visualized by MRI in this study have been previously if indirectly postulated in other studies using EMG measurements [1,20,36,40].…”

Section: Discussionmentioning

confidence: 88%

“…Interestingly, an increase in the CSA of the TFL was also demonstrated in this group after 12 months. We saw a higher-grade degeneration of the gluteus medius in the mDL approach group in connection with surgery-related denervation of the anterior part of the muscle [17,40]. The incision can cause damage to the lower branches of the superior gluteal nerve, which runs between the gluteus medius and minimus, while a lack of reintegration of the gluteal tendon accompanied by atrophy is also possible [13,17].…”

Section: Discussionmentioning

confidence: 99%

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Evidence of Reduced Muscle Trauma Through a Minimally Invasive Anterolateral Approach by Means of MRI

Müller

Tohtz

Dewey

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Minimally invasive techniques in THA are intended to minimize periarticular muscle trauma. The lateral approach has a risk of partial gluteal insufficiency, while the anterolateral approach carries the risk of damaging the tensor fasciae latae through intermuscular nerve and compression injury. Questions/purposes We assessed the surgical influence of the anterolateral minimally invasive approach and the modified direct lateral approach on the tensor fasciae latae and gluteus medius. Methods We prospectively randomized 44 patients with primary coxarthrosis to receive a cementless THA via the anterolateral minimally invasive approach or the modified direct lateral approach. We performed clinical and MRI examinations preoperatively and 3 and 12 months postoperatively, including Harris hip and pain scores. MRI analysis included assessment of the tensor fasciae latae and gluteus medius with regard to fatty atrophy and changes in the muscle cross-sectional area.Results Clinical scores were similar in the two groups but a low-grade Trendelenburg sign was observed more frequently in the lateral group. MRI showed a pronounced, postoperative fatty atrophy of the anterior part of the gluteus medius more often; and a compensatory hypertrophy of the tensor fasciae latae occurred. Higher-grade atrophy of the tensor fasciae latae and gluteus medius did not occur with the anterolateral approach. Conclusions We found no increased damage to the tensor fasciae latae with the anterolateral approach. The lateral approach was associated with increased partial gluteus atrophy and a compensatory hypertrophy of the tensor fasciae latae. Based on fewer structural changes in the musculature, we recommend the anterolateral minimally invasive approach.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Evidence of Reduced Muscle Trauma Through a Minimally Invasive Anterolateral Approach by Means of MRI

Müller

Tohtz

Dewey

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…During minimal direct lateral approach to the hip the inferior branches within the gluteal medius are at risk and in minimal anterolateral approach to the hip, branches of the SGN to the tensor fasciae latae muscle may get affected (18). Lavigne and Loriot de Rouvray defi ned a safe area, which is 7 cm above and behind the greater trochanter, 5 cm above its posterior angle and 3 cm above its anterior angle.…”

Section: Discussionmentioning

confidence: 99%

Morphology of the superior gluteal nerve: a study in adult human cadavers

Ray

D’Souza

Saxena³

et al. 2013

BLL

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Abstract:The superior gluteal nerve (SGN) arises from the sacral plexus and enters the gluteal region above the piriformis where it divides into superior and an inferior branches. Former ends in the gluteus medius and occasionally gluteus minimus whereas latter supplies gluteus medius and minimus and ends in tensor fascia latae. Variations, relations, branching pattern and length of the SGN were reported in earlier studies. The present study was conducted to establish preliminary data on the length and branching pattern of the SGN and its relations with the neighbouring bony landmarks. Twenty two lower extremities were examined in 22 male and 13 female formalin fi xed cadavers. Tip of the greater trochanter was determined as the point of reference. Statistical analysis was done using student's T test. Present study will help orthopedicians performing total hip replacement through lateral and transgluteal approaches (Tab. 3, Fig. 4, Ref. 19). Full Text in PDF www.elis.sk. Key words: superior gluteal nerve, greater sciatic foramen, greater trochanter, piriformis, gluteus medius, gluteus minimus, tensor fascia latae. Department of Anatomy, Kasturba Medical College, Manipal, KarnatakaAddress of correspondence: B. Ray, Dr, Department of Anatomy, AIIMS Bhopal, Saket Nagar, Bhopal, Madhya PradeshThe superior gluteal nerve (SGN) arises from the sacral plexus by the dorsal divisions of ventral rami of fourth, fi fth lumbar and fi rst sacral nerves (1). It is formed within the pelvis and emerges out through the greater sciatic foramen (GSF) above the piriformis. It divides into superior and inferior branches in its further course. The superior branch ends in the gluteus medius and occasionally in the gluteus minimus. The inferior branch supplies the gluteus medius and minimus and ends in the tensor fascia latae.There are various conditions which cause pain in the hip area like arthritis, bursitis, tendonitis and fractures. Surgical treatment of arthritis of the hip joint has dramatically modifi ed in the past decade. With the advent of surgical reconstructive techniques, the pathological conditions return to near normal in few months. In the surgical approaches, splitting and refl ecting forward the anterior part of the gluteus medius and the vastus lateralis is performed as a single sheet to reattach subsequently to the greater trochanter. Most often complications in aforementioned procedures are due to the damage of blood vessels, nerves or secondary complications like infections. If the splitting of the gluteus medius is more than a few centimeter superior to the tip of the greater trochanter then the SGN and the superior gluteal vessels are at risk and it may lead to positive Trendelenburg sign with lurching gait (2).Incidence of physical damage to the SGN depends largely on its course and branching pattern (Khan and Knowles, 2007). Several authors have reported about its distance from the greater trochanter and the safe area for the SGN during approaches to the hip joint (4-14).Objective of the present study was to e...

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“…Beim anterolateralen Zugang besteht außerdem das Risiko einer Schädigung kaudaler Äste des N. glutaeus superior. Vor allem bei der Präpara-tion des Femurschafts kann es zu einer Schädigung des kaudalen Astes kommen, der den M. tensor fasciae latae innerviert [19]. Um dem vorzubeugen, muss auch hier die Lage des Hautschnitts sorgsam gewählt werden.…”

Section: Anterolateraler Zugangunclassified

Nervenläsionen nach minimal-invasiver Hüftendoprothetik

et al. 2012

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Although there is no clear evidence, minimally invasive hip arthroplasty seems to be associated with slightly higher complication rates compared to standard procedures. Major nerve palsy is one of the least common but most distressing complications. The key for minimizing the incidence of nerve lesions is to analyze preoperative risk factors, accurate knowledge of the anatomy and minimally invasive techniques. Once clinical signs of nerve injury are evident, the first diagnostic steps are localization of the lesion and quantification of the damage pattern. Therefore, clinical assessment of the neurological deficits should be performed as soon as possible. Apart from rare cases of isolated transient conduction blockade or complete transection, the damage pattern is mostly combined. Thus, there can be evidence for dysfunction of nerve conduction (neuropraxia) and structural nerve damage (axonotmesis or neurotmesis) simultaneously. Because the earliest signs of denervation are detectable via electromyography after 1 week, it is not possible to make any reliable prognosis within the first days after nerve injury using electrophysiological methods. This review article should serve as a guideline for prevention, diagnostics and therapy of neural lesions in minimally invasive hip arthroplasty.

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

Cited by 51 publications

References 13 publications

Evidence of Reduced Muscle Trauma Through a Minimally Invasive Anterolateral Approach by Means of MRI

Evidence of Reduced Muscle Trauma Through a Minimally Invasive Anterolateral Approach by Means of MRI

Morphology of the superior gluteal nerve: a study in adult human cadavers

Nervenläsionen nach minimal-invasiver Hüftendoprothetik

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