Tenotomia do glúteo máximo em artroplastia total do quadril como prevenção de lesão do nervo ciático

Paiva, Leonardo Morais; Oliveira, Karina Maria Alécio de; Souto, Diogo Ranier de Macedo; Neto, Silvio Leite de Macedo; Kircov, Nicolay Jorge Bonvine; Freitas, Anderson

doi:10.1016/j.rbo.2017.07.001

Cited by 1 publication

(3 citation statements)

References 4 publications

(19 reference statements)

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“…The authors did not observe any sciatic nerve lesions among 752 hips undergoing full release of the GMT but reported 3 patients with nerve damage among 804 hips that did not undergo tenotomy and were included in the control group. 19 Paiva et al 28 performed gluteus maximus tenotomy in a patient with 5.5 cm limb dysmetria who underwent hip replacement surgery, and they assessed the fibular and tibial branches of the sciatic nerve before and after tenotomy with electro neurophysiological monitoring. The authors found that tenotomy especially improved the motor response of the fibular component of the sciatic nerve.…”

Section: Discussionmentioning

confidence: 99%

“…The authors found that tenotomy especially improved the motor response of the fibular component of the sciatic nerve. 28…”

Section: Discussionmentioning

confidence: 99%

“…The authors found that tenotomy especially improved the motor response of the fibular component of the sciatic nerve. 28 There are numerous studies in the literature on the somatosensory evoked potential (SEP) changes in the sciatic nerve that occur due to compression during joint positioning. 17,29,30 For example, Stone, Black and Pereles reported that extremity positioning, especially during the preparation of the femoral canal, causes SEP changes, regardless of the type of incision selected.…”

Section: Discussionmentioning

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%

“…The authors found that tenotomy especially improved the motor response of the fibular component of the sciatic nerve. 28…”

Section: Discussionmentioning

confidence: 99%