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Anatomical and CT angiographic study of superior gluteal neurovascular pedicle: implications for hip surgery

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Abstract

Purpose

To identify the site of incision with the lowest risk of injury of the superior gluteal neurovascular pedicle in the total hip arthroplasty with Hardinge’s direct lateral approach.

Methods

Eight fresh donated bodies were dissected and the branches of the superior gluteal nerve (SGN) and superior gluteal artery (SGA) were dissected. The distance between the SGA and the apex of greater trochanter (GT) was also evaluated in vivo in 29 patients by CT angiography.

Results

We observed 12 spray pattern and 4 transverse neural trunk pattern of the SGN. In all cases the nerve runs inferiorly to the artery, with a mean distance of 0.5 cm. At the CT angiography the average distance between the main branch of SGA and the GT was 5.2 cm, indicating a mean distance of 4.7 cm from the SGN to the GT. Terminal branches of SGA are found until 2.7 cm from GT.

Conclusions

This study analyzed the relationships between superior gluteal neurovascular pedicle and the GT in vivo (considering also the muscular tone), showing that during direct lateral access a safe area of 4.7 cm exists from the GT to the SGN and of 3.5 cm to its lower rami.

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References

  1. Abitbol JJ, Gendron D, Laurin CA, Beaulieu MA (1990) Gluteal nerve damage following total hip arthroplasty. A prospective analysis. J Arthroplasty 5:319–322. doi:10.1016/S0883-5403(08)80090-3

    Article  PubMed  CAS  Google Scholar 

  2. Altman DT, Jones CB, Routt ML Jr (1999) Superior gluteal artery injury during iliosacral screw placement. J Orthop Trauma 13:220–227

    Article  PubMed  CAS  Google Scholar 

  3. Apaydin N, Kendir S, Loukas M, Tubbs RS, Bozkurt M (2012) Surgical anatomy of the superior gluteal nerve and landmarks for its localization during minimally invasive approaches to the hip. Clin Anat [Epub ahead of print]. doi: 10.1002/ca.22057

  4. Baker AS, Bitounis VC (1989) Abductor function after total hip replacement. An electromyographic and clinical review. J Bone Joint Surg Br 71:47–50

    PubMed  CAS  Google Scholar 

  5. Basarir K, Ozsoy MH, Erdemli B, Bayramoglu A, Tuccar E, Dincel VE (2008) The safe distance for the superior gluteal nerve in direct lateral approach to the hip and its relation with the femoral length: a cadaver study. Arch Orthop Trauma Surg 128:645–650. doi:10.1007/s00402-007-0449-x

    Article  PubMed  Google Scholar 

  6. Bauer R, Kerschbaumwe F, Poisel S, Oberthaler W (1979) The transgluteal approach to the hip joint. Arch Orthop Trauma Surg 95:47–49. doi:10.1007/BF00379169

    Article  PubMed  CAS  Google Scholar 

  7. Bland JM, Altman DG (2010) Statistical methods for assessing agreement between two methods of clinical measurement. Int J Nurs Stud 47:931–936. doi:10.1016/j.ijnurstu.2009.10.001

    Article  Google Scholar 

  8. Bos JC, Stoeckart R, Klooswijk AI, van Linge B, Bahadoer R (1994) The surgical anatomy of the superior gluteal nerve and anatomical radiologic bases of the direct lateral approach to the hip. Surg Radiol Anat 16:253–258. doi:10.1007/BF01627679

    Article  PubMed  CAS  Google Scholar 

  9. Duparc F, Thomine JM, Dujardin F, Durand C, Lukaziewicz M, Muller JM, Freger P (1997) Anatomic basis of the direct lateral approach to the hip-joint by anterior hemimyotomy of the gluteus medius. Surg Radiol Anat 19:61–67. doi:10.1007/s00276-997-0061-3

    Article  PubMed  CAS  Google Scholar 

  10. Eksioglu F, Uslu M, Gudemez E, Atik OS, Tekdemir I (2003) Reliability of the safe area for the superior gluteal nerve. Clin Orthop Relat Res 412:111–116. doi:10.1097/01.blo.0000068768.86536.7e

    Article  PubMed  Google Scholar 

  11. Flack NA, Nicholson HD, Woodley SJ (2011) A review of the anatomy of the hip abductor muscles, gluteus medius, gluteus minimus, and tensor fascia lata. Clin Aant 25: 697–708. doi: 10.1002/ca.22004

    Google Scholar 

  12. Hardinge K (1982) The direct lateral approach to the hip. J Bone Joint Surg Br 64B:17–19

    Google Scholar 

  13. Hardy AE, Synk V (1998) Hip abductor function after the Hardinge approach: brief report. J Bone Joint Surg Br 70B:673

    Google Scholar 

  14. Ikeuchi M, Kawakami T, Yamanaka N, Okanoue Y, Tani T (2006) Safe zone for the superior gluteal nerve in the transgluteal approach to the dysplastic hip: intraoperative evaluation using a nerve stimulator. Acta Orthop 77:603–606. doi:10.1080/17453670610012674

    Article  PubMed  Google Scholar 

  15. Ince A, Kemper M, Waschke J, Hendrich C (2007) Minimally invasive anterolateral approach to the hip: risk to the superior gluteal nerve. Acta Orthop 78:86–89. doi:10.1080/17453670610013466

    Article  PubMed  Google Scholar 

  16. Jacobs LG, Buxton RA (1989) The course of the superior gluteal nerve in the lateral approach to the hip. J Bone Joint Surg Am 71:1239–1243

    PubMed  CAS  Google Scholar 

  17. Khan T, Knowles D (2007) Damage to the superior gluteal nerve during the direct lateral approach to the hip: a cadaveric study. J Arthroplasty 22:1198–1200. doi:10.1016/j.arth.2006.11.013

    Article  PubMed  Google Scholar 

  18. Lavernia CJ, Cook CC, Hernandez RA, Sierra RJ, Rossi MD (2007) Neurovascular injuries in acetabular reconstruction cage surgery: an anatomical study. J Arthroplasty 22:124–132. doi:10.1016/j.arth.2006.02.082

    Article  PubMed  Google Scholar 

  19. Lavigne P, Loriot de Rouvray TH (1994) The superior gluteal nerve. Anatomical study of its extrapelvic portion and surgical resolution by trans-gluteal approach. Rev Chir Orthop Reparatrice Appar Mot 80:188–195

    PubMed  CAS  Google Scholar 

  20. Leydo R (1984) Injury of the superior gluteal artery during hip joint alloplasty. Chir Narzadow Ruchu Ortop Pol 49:461–462

    PubMed  CAS  Google Scholar 

  21. Lozman H, Robbins H (1983) Injury to the superior gluteal artery as a complication of total hip-replacement arthroplasty. A case report. J Bone Joint Surg Am 65:268–269

    PubMed  CAS  Google Scholar 

  22. Miljković N, Ercegan G, Harhaji V (2007) Complications of revision hip arthroplasty using fresh bone allografts. Med Pregl 60:457–463

    Article  PubMed  Google Scholar 

  23. Mulliken BD, Rorabeck CH, Bourne BB, Nayak N (1998) A modified direct lateral approach in total hip arthroplasty: a comprehensive review. J Arthroplasty 13:737–747. doi:10.1016/S0883-5403(98)90024-9

    Article  PubMed  CAS  Google Scholar 

  24. Nazarian S, Tisserand P, Brunet C, Müller ME (1987) Anatomic basis of the transgluteal approach to the hip. Surg Radiol Anat 9:27–35. doi:10.1007/BF02116851

    Article  PubMed  CAS  Google Scholar 

  25. Pérez MM, Llusá M, Ortiz JC, Lorente M, Lopez I, Lazaro A, Pérez A, Götzens V (2004) Superior gluteal nerve: safe area in hip surgery. Surg Radiol Anat 26:225–229

    Article  PubMed  Google Scholar 

  26. Picado CH, Garcia FL, Marques W (2007) Damage to the superior gluteal nerve after direct lateral approach to the hip. Clin Orthop Relat Res 455:209–211. doi:10.1097/01.blo.0000238805.87411.e8

    Article  PubMed  Google Scholar 

  27. Ramesh M, O’Byrne JM, McCarthy N, Jarvis A, Mahalingham K, Cashman WF (1996) Damage to the superior gluteal nerve after the Hardinge approach to the hip. J Bone Joint Surg Br 78:903–906. doi:10.1302/0301-620X78B6.1289

    Article  PubMed  CAS  Google Scholar 

  28. Seddon HJ (1943) Three types of nerve injury. Brain 66:237. doi:10.1093/brain/66.4.237

    Article  Google Scholar 

  29. Siebenrock KA, Rosler KM, Gonzalez E, Ganz R (2000) Intraoperative electromyography of the superior gluteal nerve during lateral approach to the hip for arthroplasty: a prospective study of 12 patients. J Arthroplasty 15:867–870. doi:10.1054/arth.2000.8099

    Article  PubMed  CAS  Google Scholar 

  30. Zhang XL, Shen H, Qin XL, Wang Q (2008) Anterolateral muscle sparing approach total hip arthroplasty: an anatomic and clinical study. Chin Med J 121:1358–1363

    PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Section of Anatomy, Department of Molecular Medicine, University of Padova, Padua, Italy

    Carla Stecco, Veronica Macchi, Andrea Porzionato & Raffaele De Caro

  2. Clinic of Orthopaedic Surgery, Department of Surgery, University of Padova, Padua, Italy

    Luca Baggio, A. Berizzi & Roberto Aldegheri

  3. Section of Anatomy, Department of Human Anatomy and Physiology, University of Padova, via A Gabelli 65, 35127, Padua, Italy

    Carla Stecco

Authors
  1. Carla Stecco
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  2. Veronica Macchi
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  3. Luca Baggio
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  4. Andrea Porzionato
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  5. A. Berizzi
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  6. Roberto Aldegheri
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  7. Raffaele De Caro
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Correspondence to Carla Stecco.

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Stecco, C., Macchi, V., Baggio, L. et al. Anatomical and CT angiographic study of superior gluteal neurovascular pedicle: implications for hip surgery. Surg Radiol Anat 35, 107–113 (2013). https://doi.org/10.1007/s00276-012-1014-z

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  • DOI: https://doi.org/10.1007/s00276-012-1014-z

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