• David Putzer, Matthias Haselbacher, Romed Hörmann, Martin Thaler, and Michael Nogler.
• Experimental Orthopaedics, Department of Orthopaedic Surgery, Medical University of Innsbruck, Innrain 36 15, 6020, Innsbruck, Austria. david.putzer@i-med.ac.at.
• Arch Orthop Trauma Surg. 2018 Mar 1; 138 (3): 419-425.

IntroductionGluteal insufficiency is of concern with lateral approaches to total hip arthroplasty. Damage to the branches of the superior gluteal nerve may cause degeneration of the innervated muscles. The direct anterior approach exploits the intermuscular and internerval interval between tensor fasciae latae laterally and sartorius and rectus femoris muscle medially. In this study, the distance of the superior gluteal nerve in relation to anatomical landmarks was determined.Materials And MethodsTwo experienced surgeons implanted trial components in 15 alcohol glycerol fixed cadavers with 30 hips. The trials were removed, and the main branch of the superior gluteal nerve and muscular branches of the nerve were exposed from lateral.ResultsNo visual damage to the main nerve branches and the location of the nerve in relation to the greater trochanter were noted by an experienced surgeon. The superior gluteal nerve and its muscular branches crossed the muscular interval between the gluteus medius and tensor fasciae latae muscles at a mean distance of 39 mm from the tip of the greater trochanter.ConclusionsThe direct anterior approach for total hip arthroplasty minimizes the risk of injuring the superior gluteal nerve, which may result in a gluteal insufficiency. Special care should be paid on avoiding overstretching the tensor fasciae latea muscle using minimum force on retractors during surgery and by taking care of the entrance point of the superior gluteal nerve to the tensor fasciae latae.

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