Lesion of Gluteal Nerves and Muscles in Total Hip Arthroplasty through 3 Surgical Approaches. An Electromyographically Controlled Study

Chomiak, J; Huracek, J.; Dvořák, Jiří; Dungl, P; Kubeš, R; Schwarz, O; Munzinger, U.

doi:10.5301/hipint.5000199

Cited by 24 publications

(14 citation statements)

References 31 publications

(52 reference statements)

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“…For example, rhythmical, spontaneous contractions such as positive sharp waves and fibrillation potentials were used in Waschke et al ( 19 ) and considered as signs of denervation, since the muscle activity functions independent of intentional activation. Alternatively, axonal injury can be used as a metric for surgical approach quality [e.g., ( 24 )], which can be detected in the shape of polyphasic potentials and usually leads to a lower rate of motor unit recruitment. The motor unit recruitment can be measured based on the maximum voluntary contraction [as used in Waschke et al ( 19 ) and Chomiak et al ( 24 )].…”

Section: Resultsmentioning

confidence: 99%

Overview of Methods to Quantify Invasiveness of Surgical Approaches in Orthopedic Surgery—A Scoping Review

et al. 2022

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BackgroundThere is a trend toward minimally invasive and more automated procedures in orthopedic surgery. An important aspect in the further development of these techniques is the quantitative assessment of the surgical approach. The aim of this scoping review is to deliver a structured overview on the currently used methods for quantitative analysis of a surgical approaches' invasiveness in orthopedic procedures. The compiled metrics presented in the herein study can serve as the basis for digitization of surgery and advanced computational methods that focus on optimizing surgical procedures.MethodsWe performed a blinded literature search in November 2020. In-vivo and ex-vivo studies that quantitatively assess the invasiveness of the surgical approach were included with a special focus on radiological methods. We excluded studies using exclusively one or multiple of the following parameters: risk of reoperation, risk of dislocation, risk of infection, risk of patient-reported nerve injury, rate of thromboembolic event, function, length of stay, blood loss, pain, operation time.ResultsThe final selection included 51 articles. In the included papers, approaches to 8 different anatomical structures were investigated, the majority of which examined procedures of the hip (57%) and the spine (29%). The different modalities to measure the invasiveness were categorized into three major groups “biological” (23 papers), “radiological” (25), “measured in-situ” (14) and their use “in-vivo” or “ex-vivo” was analyzed. Additionally, we explain the basic principles of each modality and match it to the anatomical structures it has been used on.DiscussionAn ideal metric used to quantify the invasiveness of a surgical approach should be accurate, cost-effective, non-invasive, comprehensive and integratable into the clinical workflow. We find that the radiological methods best meet such criteria. However, radiological metrics can be more prone to confounders such as coexisting pathologies than in-situ measurements but are non-invasive and possible to perform in-vivo. Additionally, radiological metrics require substantial expertise and are not cost-effective. Owed to their high accuracy and low invasiveness, radiological methods are, in our opinion, the best suited for computational applications optimizing surgical procedures. The key to quantify a surgical approach's invasiveness lies in the integration of multiple metrics.

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Section: Resultsmentioning

confidence: 99%

Overview of Methods to Quantify Invasiveness of Surgical Approaches in Orthopedic Surgery—A Scoping Review

et al. 2022

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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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“…Тем не менее касательно последствий эндопротезирования следует учитывать, что порция отводящего аппарата с сохранной фиксацией к большому вертелу сама по себе может обладать достаточной силой [6] и постепенно прогрессирующее расхождение сухожильного комплекса может быть компенсировано [12]. Также электронейромиографически выявленная денервация мышц может иметь преходящий характер [2], и с течением времени может быть достигнута реиннервация и компенсаторная активации оставшихся моторных волокон [13]. Наконец походка в послеоперационном периоде зависит не только от отводящего аппарата, но и от других групп мышц бедра, в частности разгибателей [15], имеющих свой потенциал к восстановлению.…”

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“…Так J. Chomiak с соавт. отметили, что данный доступ сопряжен с развитием электронейромиографических признаков частичной денервации m. gluteus medius в 81,8 % случаев и m. tensor fasciae latae в 48 % случаев[13], а по данным A.S. Baker с соавт. при прямом латеральном доступе в классическом исполнении наблюдалась денервация напрягателя широкой фасции в 10 случаях из 29 в раннем периоде (из них в 5 случаях нарушения сохранялись к сроку 3 месяца)[2].…”

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Reconstruction of the Hip Abductors After Total Hip Arthroplasty

Андреев¹,

Goncharov²,

Ефимов³

2021

СПНО (MPSE)

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Одним из наиболее часто используемых хирургических доступов при эндопротезировании тазобедренного сустава является прямой боковой по Хардингу. При этом нередко возникают сложности с восстановлением отводящей группы мышц бедра в интра-и послеоперационном периоде. Цель исследования -определить частоту возникновения недостаточности отводящего аппарата бедра после эндопротезирования тазобедренного сустава из чрезъягодичного доступа и эффективность ее лечения. Проспективно было изучено 883 случая эндопротезирования тазобедренного сустава из чрезъягодичного доступа у 883 пациентов. Плановый осмотр пациентов в послеоперационном периоде проводился через 3 месяца. Осмотр включал определение симптома Тренделенбурга, оценку функционального статуса по шкале Харриса, наличие болевого синдрома и его интенсивность по ВАШ. Пациентам, которым диагностировали дисфункцию средней и малой ягодичных мышц, назначалось консервативное лечение, наблюдение в следующие 6 и 12 месяцев после операции, дополнительное обследование. Пяти пациентам, у которых через год после операции определялась слабость отводящего аппарата мышц бедра, выполнялась операция: рефиксация средней и малой ягодичных мышц. Недостаточность функции отводящего аппарата бедра после ЭПТБС из чрезъягодичного доступа встречается часто, но может разрешаться на фоне консервативного лечения в срок до одного года после операции. В случае неэффективности проводимого восстановительного лечения мы рекомендуем выполнение УЗИ ТБС. При наличии сонографических признаков отрыва сухожилий средней и малой ягодичных мышц оперативное лечение в объеме рефиксации может обеспечивать восстановление ходьбы без хромоты и дополнительной опоры. Ключевые слова: хирургический доступ, эндопротезирование тазобедренного сустава, повреждение абдукторов бедра

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Lesion of Gluteal Nerves and Muscles in Total Hip Arthroplasty through 3 Surgical Approaches. An Electromyographically Controlled Study

Abstract: Despite some disadvantages associated with the anterolateral approach, the transgluteal and posterior approaches are often connected with a partial lesion of the gluteus medius and maximus muscles. In all approaches, clinical sequelae are not significant in primary THA.

Cited by 24 publications

References 31 publications

Overview of Methods to Quantify Invasiveness of Surgical Approaches in Orthopedic Surgery—A Scoping Review

Overview of Methods to Quantify Invasiveness of Surgical Approaches in Orthopedic Surgery—A Scoping Review

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

Reconstruction of the Hip Abductors After Total Hip Arthroplasty

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