Position of the sciatic nerve and effect of gluteus maximus release during hip arthroplasty

Kanawati, Andrew; Narulla, Rajpal; Lorentzos, Peter; Graham, Edward

doi:10.1016/j.jor.2017.03.011

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…With internal rotation and flexion of the hip, the sciatic nerve becomes closer to the femoral neck, while the gluteal sling begins to compress the nerve distally. 3,7 Nerve damage may vary depending on the amount and duration of the pressure applied. A pressure increase of as little as 20 mmHg may result in venous stasis, which may lead to extraneural edema, whereas a 80 mmHg pressure increase stops all intraneural blood flow.…”

Section: Discussionmentioning

confidence: 99%

“…The release of the GMT increases the distance between the femoral neck and the sciatic nerve, especially at 90° of flexion of the hip, and facilitates hip dislocations without significant nerve disruption. 7 Tenotomy also prevents the GMT from compressing the sciatic nerve during internal rotation and flexion of the hip. 3 Theoretically, weakness of gluteus maximus in a healthy subject without hip osteoarthritis may lead to deterioration in rapid acceleration of the body upward and forward from a position of hip flexion, such as when pushing off into a sprint, arising from a deep squat, or climbing a steep hill.…”

Section: Introductionmentioning

confidence: 99%

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The effect of gluteus maximus tenotomy in primary total hip arthroplasty with posterior approach: Kinematic analysis of hip extensor strength

İmren

Karslıoğlu

Dedeoğlu

et al. 2021

J Orthop Surg (Hong Kong)

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Background: The posterior approach (PA) is the most commonly used surgical approach for total hip arthroplasty (THA), but the proximity of the sciatic nerve may increase the likelihood of sciatic nerve injury (SNI). Gluteus maximus tenotomy can be performed to prevent SNI because tenotomy increases the distance between the femoral neck and sciatic nerve and prevents compression of the sciatic nerve by the gluteus maximus tendon (GMT) during hip movements. We aimed to kinematically compare the postoperative hip extensor forces of patients who have and have not undergone gluteus maximus tenotomy to determine whether there is a difference in hip extensor strength. Methods: Seventy-two patients who underwent gluteus maximus tenotomy during THA were included in the group 1, and 86 patients who did not undergo tenotomy were included in group 2. The Harris hip score, body mass index and hip extensor forces were measured both preoperatively, and 6 months after surgery with an isokinetic dynamometer and compared. Results: The mean age was 64.6 ± 2.3 years in group 1 and 63.8 ± 2.1 in group 2. Mean body mass index was 25.7 ± 1.1 in group 1, and 25.5 ± 1.3 in group 2. Baseline Harris hip score (HHS) was 42.36 ± 12 in group 1 and 44.07 ± 9.4 in group 2 (p = 0.31), whereas it was 89.1 ± 7.8 and 88.4 ± 8.1 at 6 months after surgery, respectively. Baseline hip extensor force (HEF) was 2 ± 0.4 Nm/kg in group 1, and 2.1 ± 0.7 Nm/kg in group 2 (p = 0.28), while it was 2.4 ± 0.6 Nm/kg, and 2.5 ± 0.5 Nm/kg, respectively at 6 month follow-up (p = 0.87). Both groups had significantly improved HHS and HEF when comparing baseline and postoperative measurements (p < 0.0001). No cases of sciatic nerve palsy were noted in group 1, whereas there were two (2.32%) cases in group 2, postoperatively. Conclusion: The release of the GMT during primary hip arthroplasty performed with the PA did not lead to significant decrease in hip extension forces. Hip extensor strength improves after THA regardless of tenotomy. Gluteus maximus tenotomy with repair does not reduce muscle strength and may offer better visualization.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The effect of gluteus maximus tenotomy in primary total hip arthroplasty with posterior approach: Kinematic analysis of hip extensor strength

İmren

Karslıoğlu

Dedeoğlu

et al. 2021

J Orthop Surg (Hong Kong)

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“…A posterior approach to the hip was performed. A partial release of the gluteus maximus tendon was performed to reduce the tension of the sciatic nerve [20]. After dislocation, the loose proximal component and the old trunnion were removed by hand.…”

Section: Surgical Technique (Video)mentioning

confidence: 99%

Revision of a Fractured Titanium Modular Revision Hip Stem Without Removal of the Well-Fixed Part of the Stem: A New Approach Using a Cemented Tube

et al. 2020

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Component fracture is a rare cause for revision in total hip arthroplasty. For a fractured well-fixed long femoral stem, the options are limited. We sought to develop a technique to address this problem with lower morbidity. A newly developed cemented tube was constructed and cemented onto a fractured Revitan revision hip femoral stem to retain the distal well-fixed component. At the 2-year follow-up, the Harris Hip Score, pain level, and radiographic images were analyzed. At the 2-year follow-up, no radiological signs of loosening or failure could be observed. The patient's preoperative Harris Hip Score improved from 42.8 to 97 points. The pain level improved from 7/10 to 0/10. Our case report depicts excellent clinical and radiographic outcomes at 2-year follow-up by a newly developed cemented tube technique. This technique is a potential new option for revision of fractured well-fixed diaphyseal stems without major bone loss. Our successful results suggest this technique is worthy of consideration and further study.

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Nerve Injury After Total Hip Arthroplasty

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2021

Peripheral Nerve Issues After Orthopedic Surgery

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Position of the sciatic nerve and effect of gluteus maximus release during hip arthroplasty

Cited by 3 publications

References 9 publications

The effect of gluteus maximus tenotomy in primary total hip arthroplasty with posterior approach: Kinematic analysis of hip extensor strength

The effect of gluteus maximus tenotomy in primary total hip arthroplasty with posterior approach: Kinematic analysis of hip extensor strength

Revision of a Fractured Titanium Modular Revision Hip Stem Without Removal of the Well-Fixed Part of the Stem: A New Approach Using a Cemented Tube

Nerve Injury After Total Hip Arthroplasty

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