Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/99594
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Type: Journal article
Title: An extended posterior approach to the hip and pelvis for complex acetabular reconstruction that preserves the gluteal muscles and their neurovascular supply
Author: Solomon, L.
Hofstaetter, J.
Bolt, M.
Howie, D.
Citation: Bone and Joint Journal, 2014; 96-B(1):48-53
Publisher: British Editorial Society of Bone and Joint Surgery
Issue Date: 2014
ISSN: 2049-4394
2049-4408
Statement of
Responsibility: 
L.B. Solomon, J.G. Hofstaetter, M.J. Bolt, D.W. Howie
Abstract: We investigated the detailed anatomy of the gluteus maximus, gluteus medius and gluteus minimus and their neurovascular supply in 22 hips in 11 embalmed adult Caucasian human cadavers. This led to the development of a surgical technique for an extended posterior approach to the hip and pelvis that exposes the supra-acetabular ilium and preserves the glutei during revision hip surgery. Proximal to distal mobilisation of the gluteus medius from the posterior gluteal line permits exposure and mobilisation of the superior gluteal neurovascular bundle between the sciatic notch and the entrance to the gluteus medius, enabling a wider exposure of the supra-acetabular ilium. This technique was subsequently used in nine patients undergoing revision total hip replacement involving the reconstruction of nine Paprosky 3B acetabular defects, five of which had pelvic discontinuity. Intra-operative electromyography showed that the innervation of the gluteal muscles was not affected by surgery. Clinical follow-up demonstrated good hip abduction function in all patients. These results were compared with those of a matched cohort treated through a Kocher-Langenbeck approach. Our modified approach maximises the exposure of the ilium above the sciatic notch while protecting the gluteal muscles and their neurovascular bundle.
Keywords: Hip; extended approach; Revision ; Total hip replacement; Superior gluteal bundle; Gluteus medius
Rights: © 2014 The British Editorial Society of Bone & Joint Surgery
RMID: 0030011363
DOI: 10.1302/0301-620X.96B1.31464
Appears in Collections:Orthopaedics and Trauma publications

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