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A Risk for Anterior Hip Approach

Posted on: 03/10/2016
The anterior approach for hip surgeries has become more popular in recent years because of minimal trauma to muscles compared to the posterior (back side) approach. Although this has been well documented, there is some concern about nerve damage when utilizing the anterior approach. This study aims to evaluate the risk for nerve injury to the superior gluteal nerve (a nerve that controls motor function for the tensor fascia latte), and itís location is in the area of anterior approach to hip surgery. In this study the authors use cadavers to more clearly understand the course of the superior gluteal nerve and to establish the high risk zones for the anterior approach.

Twelve cadaver specimens were utilized for this study, six were female and six male, with several bilateral sides giving nineteen total hips to be dissected. The researches first located the superior gluteal nerve from a posterior approach, marked it and then turned the specimens to begin the anterior approach. What these researchers found was some variability in the terminal branch of the superior gluteal nerve where it enters the tensor fascia latte, but also some useful consistency. Two nerve branches were found in fourteen cases, one branch was found in four cases and three branches were found in one case. These nerve branches entered the tensor fascia latte between zero and ten mm proximal to the location of entry of the lateral circumflex femoral artery (LCFA) to the tensor fascia latte. And the mean location of entry of this artery was between forty one and fifty four percent of the muscle moving down from its proximal attachment along the iliac crest, basically at the half way point.

The important thing to note in this study is that the LCFA is found and used as a landmark during anterior approach to hip surgery. The tensor fascia latte is also used as the outside border of the incision, and generally pulled with a clamp to expose the hip joint capsule. The superior gluteal nerve is likely to be in this area, but with knowledge of itís usual anatomy there can be caution taken not to damage this nerve by clamping, coagulation or cutting too close to this artery branch. If there is injury to this nerve during surgery this may result in weakness or paralysis of the tensor fascia latte. There is some discussion that damage to this nerve will not effect the functional outcome following surgery, however this muscle is an important muscle in normal gait and the effect of damage to it is debatable.

According to this study there are consistent anatomical landmarks for location of the superior gluteal nerve and this knowledge should be considered in order to decrease potential damage during surgery.

References:
Grab, Karl, MD. et al. Potential Risk to the Superior Gluteal Nerve During the Anterior Approach to the Hip Joint. In The Journal of Bone and Joint Surgery. September 2015. Vol. 97-A. No. 17. Pp. 1426-1431.

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