The Kocher-Langenbeck Approach

Tosounidis, Theodoros H.; Giannoudis, Vasillios P.; Kanakaris, Nikolaos K.; Giannoudis, Peter V.

doi:10.2106/jbjs.st.16.00102

Cited by 37 publications

(24 citation statements)

References 18 publications

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“…Retracting the external rotators posteriorly away from the trochanter effectively creates a sling that also pulls the SN out of the operating field. 8,9 The incidence of SN palsy following THA ranges from 0.05% *Variant types included types B, G and the unclassified type to 1.9%. 21 During THA, the disruption of the insertion of the PM may predispose the SN to stretching, particularly in cases where a variant relationship exists.…”

Section: Discussionmentioning

confidence: 99%

“…Posterior surgical approaches to the hip include the Moore or Southern approach, used mostly for hip arthroplasty procedures, and the Kocher-Langenbeck approach, typically used to visualise the posterior acetabulum. 8,9 In arthroscopy, the joint is visualised with an arthroscope and instruments are introduced from one of several portals or standardised points of access to avoid critical structures. 10 One of these portals, the postero-lateral portal, lies 2 cm posterior to the tip of the greater trochanter and has been associated with occasional injury to the SN, especially if the limb is positioned in external rotation.…”

Section: Introductionmentioning

confidence: 99%

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Surgical anatomy of the sciatic nerve and its relationship to the piriformis muscle with a description of a rare variant

et al. 2020

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Aims: Variation of the sciatic nerve may increase the risk of iatrogenic injury during total hip arthroplasty or arthroscopy, result in failure of peripheral blocks, or be associated with piriformis syndrome. Studies from Africa are scarce, with none to date from South Africa. Thus, the aims were to document the relationship between the sciatic nerve and piriformis muscle, variation in the bifurcation level and in the length of the nerve. Any significant differences between sexes and sides were also investigated. Methods: The lower limbs of 42 cadavers (84 limbs) were dissected and the relationship between the sciatic nerve and piriformis classified according to the patterns described by Beaton and Anson. The region of sciatic nerve bifurcation was documented, and the length of the nerve was measured in individuals with bifurcation in the thigh. Results: The normal relationship between the sciatic nerve and piriformis muscle was present in 64 limbs (76.2%). The bifurcation level of the nerve was variable in more than half the sample. No significant differences occurred in any of the variant patterns or bifurcation regions between side or sex; however, variations were more common in females than in males. The mean length of the sciatic nerve was 133.30±19.33 mm, with no differences in length between sex or side. Conclusion: Variations in the anatomy of the sciatic nerve occurred in up to half of the sample, which may have implications for increased risk of iatrogenic injury in total hip arthroplasty and arthroscopy, piriformis syndrome or sciatic block failure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical anatomy of the sciatic nerve and its relationship to the piriformis muscle with a description of a rare variant

et al. 2020

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“…are usually applied [8][9][10], however, they occasionally show noteworthy drawbacks (e.g. long operating time and substantial blood loss) and complications (e.g.…”

Section: Introductionmentioning

confidence: 99%

Mid-term results of an anterior plating via combined anterior approach for complex acetabular fractures: a retrospective cohort study

Meng¹,

Ou²,

Wu³

et al. 2020

Preprint

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Abstract Background: Solely anterior plating via the modified Stoppa approach might yield satisfactory outcomes for selected cases of complex acetabular fractures, however, its indications are not practically clear. Methods: Patients with complex acetabular fractures treated with solely anterior plating via the modified Stoppa approach with or without a lateral window at our trauma center between January 2013 and December 2019 were retrospectively reviewed. Fracture type was identified according the newly established three-column classification of acetabular fracture. Perioperative information was recorded, and fracture reduction was evaluated radiographically at 3 days postoperatively. Postoperative hip function was assessed at least 1 year postoperatively. Results: Twenty patients were included with an average 17 months (range, 13-28) follow-up. According to the three-column classification, 2 cases were classified as type B2.2, 8 cases as type B2.3, 3 cases as type C1, and 7 cases as type C3. The mean time from injury and surgery was 7.0 days (range, 3-13 days), operative time was 2.0 hours (range, 1.4-3.2 hours), and intraoperative blood loss was 320 ml (range, 220-450 ml). Fracture reduction was excellent in 15 cases (75%), good in 3 cases (15%), fair in 1 case (5%), and poor in 1 case (5%). Final hip function was excellent in 13 cases (68%), good in 3 cases (16%), fair in 2 cases (11%), and poor in 1 case (5%). Bony healing was achieved in all cases and few complications were reported including recoverable obturator nerve injuries in 2 patients (10%) and controllable osteoarthritis in 1 patient (5%). Conclusions: Solely anterior plating via the combined anterior approach achieved satisfactory mid-term outcomes for complex acetabular fractures with posterior column detachments. Based on the newly established three-column classification of complex acetabular fracture, the type B, C1, and C3 fractures are possibly the appropriate indications for such a simplified procedure.

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“…ilioinguinal approach, pararectus approach, and modi ed Stoppa approach) and posterior approaches (e.g. Kocher-Langenbeck approach) are usually applied [8][9][10], however, they occasionally show noteworthy drawbacks (e.g. long operating time and substantial blood loss) and complications (e.g.…”

Section: Introductionmentioning

confidence: 99%

Mid-term Results of an Anterior Plating Via Combined Anterior Approach for complex Acetabular Fractures: A Retrospective Cohort Study

Meng

et al. 2020

Preprint

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Background: Solely anterior plating via the modified Stoppa approach might yield satisfactory outcomes for selected cases of complex acetabular fractures, however, its indications are not practically clear. Methods: Patients with complex acetabular fractures treated with solely anterior plating via the modified Stoppa approach with or without a lateral window at our trauma center between January 2013 and December 2019 were retrospectively reviewed. Fracture type was identified according the newly established three-column classification of acetabular fracture. Perioperative information was recorded, and fracture reduction was evaluated radiographically at 3 days postoperatively. Postoperative hip function was assessed at least 1 year postoperatively. Results: Twenty patients were included with an average 17 months (range, 13-28) follow-up. According to the three-column classification, 2 cases were classified as type B2.2, 8 cases as type B2.3, 3 cases as type C1, and 7 cases as type C3. The mean time from injury and surgery was 7.0 days (range, 3-13 days), operative time was 2.0 hours (range, 1.4-3.2 hours), and intraoperative blood loss was 320 ml (range, 220-450 ml). Fracture reduction was excellent in 15 cases (75%), good in 3 cases (15%), fair in 1 case (5%), and poor in 1 case (5%). Final hip function was excellent in 13 cases (68%), good in 3 cases (16%), fair in 2 cases (11%), and poor in 1 case (5%). Bony healing was achieved in all cases and few complications were reported including recoverable obturator nerve injuries in 2 patients (10%) and controllable osteoarthritis in 1 patient (5%). Conclusions: Solely anterior plating via the combined anterior approach achieved satisfactory mid-term outcomes for complex acetabular fractures with posterior column detachments. Based on the newly established three-column classification of complex acetabular fracture, the type B, C1, and C3 fractures are possibly the appropriate indications for such a simplified procedure.Trial registration informationThe trial was retrospectively registered in https://www.researchregistry.com (No. Researchregistry4862) on July 04, 2019. The first participant was enrolled on March 06, 2017.

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The Kocher-Langenbeck Approach

Cited by 37 publications

References 18 publications

Surgical anatomy of the sciatic nerve and its relationship to the piriformis muscle with a description of a rare variant

Surgical anatomy of the sciatic nerve and its relationship to the piriformis muscle with a description of a rare variant

Mid-term results of an anterior plating via combined anterior approach for complex acetabular fractures: a retrospective cohort study

Mid-term Results of an Anterior Plating Via Combined Anterior Approach for complex Acetabular Fractures: A Retrospective Cohort Study

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