ABSTRACT
PURPOSE: Three surgical approaches in total hip arthroplasty (THA) were compared concerning: 1) clinical and radiological results; 2) innervation of the tensor fasciae latae and gluteal muscles; 3) clinical outcome of the nerve lesions; 4) sensitivity of the EMG analysis. METHODS: A total of 70 patients aged 39-79 years were evaluated clinically and electromyographically before and 3-9 months after THA in 2 centres using the anterolateral approach in 22, transgluteal approach in 33 and posterior approach in 15 patients, respectively. RESULTS: 1) Hip flexion, external rotation and Trendelenburg lurch were reduced and the centre of the rotation was higher after the anterolateral approach. 2) The inferior branch of the superior gluteal nerve of the tensor fasciae latae muscle was mostly damaged in the anterolateral approach (73% of lesions), whereas innervations of gluteus medius (9% of lesions) and maximus muscles (no lesion) were preserved. The transgluteal approach most often caused a partially denervated gluteus medius (81.8%) and the tensor fasciae latae (48%) and the gluteus maximus muscle only in 29%, respectively. After the posterior approach, partial denervation in the gluteus medius and maximus muscles were noted in 53.3% and 71.4%, respectively, whereas in the tensor fasciae latae muscle in only 14%. 3) The power of the abductors was not significantly reduced in partially denervated muscles. 4) The EMG examination is not sensitive enough to determine the relevant power of hip abductors. CONCLUSIONS: Despite some disadvantages associated with the anterolateral approach, the transgluteal and posterior approaches are often connected with a partial lesion of the gluteus medius and maximus muscles. In all approaches, clinical sequelae are not significant in primary THA.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Hip/methods , Buttocks/innervation , Electromyography/methods , Muscle, Skeletal/innervation , Adult , Aged , Buttocks/surgery , Case-Control Studies , Female , Femoral Nerve/injuries , Hip Joint/surgery , Humans , Male , Middle Aged , Muscle, Skeletal/injuries , Peroneal Nerve/injuries , Postoperative Care/methods , Preoperative Care/methods , Reference Values , Risk AssessmentABSTRACT
INTRODUCTION: The aim of this study was to investigate the influence of triple pelvic osteotomy on the internal pelvic dimensions and thus on the potential for normal vaginal delivery. METHODS: Data were acquired by processing fixed anatomical specimens of 19 female pelves with maintained sacrotuberous and sacrospinous ligaments after unilateral and bilateral osteotomy, respectively. The specimens were measured and x-ray images and photographs were taken. RESULTS: The dimensions in the plane of the pelvic inlet and the plane of the greatest pelvic dimension after unilateral osteotomy increased in 51%, remained unchanged in 34% and in 15% of cases they decreased. The most critical locations for the passage of fetus decreased in average from 0.016 cm in distantia interspinalis in the plane of the least pelvic dimension to 0.695 cm in distantia intertuberositas in the plane of the pelvic outlet. After bilateral osteotomy are decreases more significant from 0.226 cm (2.05%) to 1.00 cm (9.51%). Decreases we observed in the monitored dimensions were not so big in comparison to other published studies. CONCLUSION: Results of this study confirm our hypothesis that unilateral triple pelvic osteotomy does not significantly narrow the bony birth canal and so it does not impede the ability to deliver per vias naturales in female patients with this surgical procedure in anamnesis. After bilateral triple osteotomy we would rather recommend Caesarean section.
