Establishment Of Safety Parameters For Hip Posterolateral Access To Cadavers' Ischiatic Nerve: An Anatomical Study [estudo Anatômico Do Nervo Isquiático Em Cadáveres: Determinação De Parâmetros De Segurança Para A Via De Acesso Póstero-lateral Do Quadril]

Orthopaedic doctors' preference for the posterolateral access of the hip demands further attention and improvement of the surgical technique in order to reduce per- and postoperative complications rates, especially the iatrogenic ones. Although neurological deficit post hip arthroplasty is an uncommon complication (about 1% of the cases), almost 80% of these cases are correlated to the ischiatic nerve or to one of its divisions. The objective of this study was to establish safety parameters for the posterolateral access of the hip, aiming to reduce the incidence rate of iatrogenic injuries of the ischiatic, tibial or fibular nerves, since this subject has not been addressed by literature so far. Twenty human cadavers' hips were studied and the shortest distance between the lateral end of the ischiatic nerve and the insertion of the quadratus muscle of the thigh was 2 mm (measured over this muscle's proximal edge). The establishment of such parameters provides orthopaedic surgeons with more confidence to go posterior and distally through the posterolateral access, but does not minimizes the level of care required to dissection and the importance of using a fine surgical technique.164230232Johnson, N.A., Pellicci, P.M., Tsairis, P., Salvati, E.A., Nerve injury in total hip arthroplasty (1983) Clin Orthop Relat Res, 170, pp. 214-222Solheim, L.F., Hagen, R., Femoral and sciatic neuropathies after total hip arthroplasty (1978) Acta Orthop Scand, 51, pp. 531-534Weber, E.R., Daube, J.R., Coventry, M.B., Peripheral neuropathies associated with total hip arthroplasty (1976) J. Bone Joint Surg Am, 58, pp. 66-69Edwards, B.N., Tullos, H.S., Noble, P.C., Contributory factors and etiology sciatic nerve palsy in total hip arthroplasty (1987) Clin Orthop Relat Res, 218, pp. 136-141Schmalzried, T.P., Amstutz, H.C., Dorey, F.J., Nerve palsy associated with total hip replacement (1991) J Bone Joint Surg Am, 73, pp. 1074-1080Schmalzried, T.P., Noordin, S., Amstutz, H.C., Update on nerve palsy associated with total hip replacement (1997) Clin Orthop Relat Res, 344, pp. 188-206Franco JS, Lourenço, PRB, Delocco FO. Vias de acesso cirúrgico ao quadril. In: Pardini Junior AG, Souza JMG, organizadores. Clínica Ortopédica. Rio de Janeiro: Médici2001. p. 949-71. 8. Jolles BM, Bogoch ER. Surgical approach for total hip arthroplasty: direct lateral or posterior? J Rheumatol 200431:1790-