Potential Risk to the Superior Gluteal Nerve During the Anterior Approach to the Hip Joint: An Anatomical Study.
BACKGROUND
The anterior approach to the hip joint is widely used in pediatric and adult orthopaedic surgery, including hip arthroplasty. Atrophy of the tensor fasciae latae muscle has been observed in some cases, despite the use of this internervous approach. We evaluated the nerve supply to the tensor fasciae latae and its potential risk for injury during the anterior approach to the hip joint.


METHODS
Cadaveric hemipelves (n = 19) from twelve human specimens were dissected. The course of the nerve branch to the tensor fasciae latae muscle, as it derives from the superior gluteal nerve, was studied in relation to the ascending branch of the lateral circumflex femoral artery where it enters the tensor fasciae latae.


RESULTS
The nerve supply to the tensor fasciae latae occurs in its proximal half by divisions of the inferior branch of the superior gluteal nerve. The nerve branches were regularly coursing in the deep surface on the medial border of the tensor fasciae latae muscle. In seventeen of nineteen cases, one or two nerve branches entered the tensor fasciae latae within 10 mm proximal to the entry point of the ascending branch of the lateral circumflex femoral artery.


CONCLUSIONS
Coagulation of the ascending branch of the lateral circumflex femoral artery and the placement of retractors during the anterior approach to the hip joint carry the potential risk for injury to the motor nerve branches supplying the tensor fasciae latae.


CONCLUSIONS
During the anterior approach, the ligation or coagulation of the ascending branch of the lateral circumflex femoral artery should not be performed too close to the point where it enters the tensor fasciae latae. The nerve branches to the tensor fasciae latae could also be compromised by the extensive use of retractors, broaching of the femur during hip arthroplasty, or the inappropriate proximal extension of the anterior approach.
Department of Orthopaedic Surgery, Kantonsspital St. Gallen, Rorschacher Strasse 95, St. Gallen CH-9007, Switzerland. E-mail address: karl.grob@kssg.ch.
Karl
K
Grob
Department of Anatomy, University of Zürich-Irchel, Winterhurerstrasse 190, Zürich CH-8507, Switzerland. E-mail address: manestar@anatom.uzh.ch.
Mirjana
M
Manestar
The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Perth, Australia. E-mail address for T. Ackland: tim.ackland@uwa.edu.au. E-mail address for M.S. Kuster: family.kuster@bluewin.ch.
Timothy
T
Ackland
Department of Anatomy, University of Fribourg, Rue A, Gockel 1, Fribourg CH-1700, Switzerland. E-mail address: luis.filgueira@unifr.ch.
Luis
L
Filgueira
The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Perth, Australia. E-mail address for T. Ackland: tim.ackland@uwa.edu.au. E-mail address for M.S. Kuster: family.kuster@bluewin.ch.
Markus S
MS
Kuster
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D002081:Buttocks / Q000294:innervation*; D002102:Cadaver; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006621:Hip Joint / Q000294:innervation / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008026:Ligation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons; D059351:Organ Sparing Treatments / Q000379:methods; D012307:Risk Factors; D013525:Surgical Instruments / Q000009:adverse effects; D020196:Trauma, Nervous System / Q000517:prevention & control*