The distance of the gluteal nerve in relation to anatomical landmarks: an anatomic study

Abstract

IntroductionGluteal insufficiency is of concern with lateral approaches to total hip arthroplasty. Damage to the branches of the superior gluteal nerve may cause degeneration of the innervated muscles. The direct anterior approach exploits the intermuscular and internerval interval between tensor fasciae latae laterally and sartorius and rectus femoris muscle medially. In this study, the distance of the superior gluteal nerve in relation to anatomical landmarks was determined.Materials and methodsTwo experienced surgeons implanted trial components in 15 alcohol glycerol fixed cadavers with 30 hips. The trials were removed, and the main branch of the superior gluteal nerve and muscular branches of the nerve were exposed from lateral.ResultsNo visual damage to the main nerve branches and the location of the nerve in relation to the greater trochanter were noted by an experienced surgeon. The superior gluteal nerve and its muscular branches crossed the muscular interval between the gluteus medius and tensor fasciae latae muscles at a mean distance of 39 mm from the tip of the greater trochanter.ConclusionsThe direct anterior approach for total hip arthroplasty minimizes the risk of injuring the superior gluteal nerve, which may result in a gluteal insufficiency. Special care should be paid on avoiding overstretching the tensor fasciae latea muscle using minimum force on retractors during surgery and by taking care of the entrance point of the superior gluteal nerve to the tensor fasciae latae.

Do Acetabular Buttress Augment Pose Risk to the Superior Gluteal Nerve? A Cadaveric Study

“…We agree with Putzer et al. [ 13 ] that the use of a flexible ruler could lead to some measurement deviation. However, we made each measurement through consensus with all 3 authors before documentation.…”

“…[ 30 ] investigated various nerve palsies in relation to total hip arthroplasty and found just 36% of those with complete neurologic injuries recovered fully. With effects as severe as recurrent dislocations, the functional deviations generated from these injuries can significantly reduce the patient’s quality of life [ 13 , 16 ]. And even if the nerve is only partially and/or transiently injured, the hip is destabilized by its lack of full abductor moment (and at increased risk of dislocation) while it recovers.…”

“…As the gluteus medius and minimus muscles are the major abductors of the hip, denervation can lead to weakness, a Trendelenburg gait, difficulty with stance, and, most-distressing to arthroplasty surgeons, dislocation. These sequelae can significantly reduce a patient’s quality of life [ [13] , [14] , [15] , [16] ].…”

“…The vast majority have been in relation to various locations on the femur’s greater trochanter [ 17 ]. The iliac crest, anterior-superior iliac spine, posterior-superior iliac spine, and superior acetabular rim have also been used [ 12 , 13 , 18 ]. Many postulate there is a “safe zone” in relation to the tip of the greater trochanter [ 17 ].…”

The Anatomical Course of the Superior Gluteal Nerve With Regard to the Direct Anterior Approach for Primary and Revision Total Hip Arthroplasty

“…Postoperative atrophy and degeneration of the TFL with a consecutive loss of function can be caused by direct mechanical damage to the muscle or injury to the SGN's terminal branches [16]. Sacred cadaver studies reported that placement of retractors and cauterization of the lateral circumflex femoral artery could, directly and indirectly, lead to injury of the terminal branches of the SGN during DAA THA [13,14]. This can lead to severe functional restrictions that severely affect the patient's everyday life because the TFL is an important thigh abductor, which holds the pelvis horizontal during the stance phase of the gait and balances the body weight and the non-weight-bearing leg when walking [1,8,22].…”