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Anatomy of piriformis, obturator internus and obturator externus: IMPLICATIONS FOR THE POSTERIOR SURGICAL APPROACH TO THE HIP.

We dissected 20 cadaver hips in order to investigate the anatomy and excursion of the trochanteric muscles in relation to the posterior approach for total hip replacement. String models of each muscle were created and their excursion measured while the femur was moved between its anatomical position...

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Published in:Journal of Bone & Joint Surgery, British Volume Vol. 92; no. 9; pp. 1317 - 1325
Main Authors: Solomon LB, Lee YC, Callary SA, Beck M, Howie DW
Format: Journal Article
Published: British Editorial Society of Bone & Joint Surgery 2010 Sep
Online Access:View this record in EBSCOhost
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      jtl: Journal of Bone & Joint Surgery, British Volume
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      dt: 2010 Sep
      vid: 92
      iid: 9
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      pub: British Editorial Society of Bone & Joint Surgery
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        105086262
        2010760116
        10.1302/0301-620X.92B9.23893
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        atl: Anatomy of piriformis, obturator internus and obturator externus: IMPLICATIONS FOR THE POSTERIOR SURGICAL APPROACH TO THE HIP.
      aug:
        au:
          Solomon LB
          Lee YC
          Callary SA
          Beck M
          Howie DW
        affil: Department of Orthopaedics, Level 4, Bice Building, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia.
      sug:
        subj:
          Hip Joint Anatomy and Histology
          Muscle, Skeletal Anatomy and Histology
          Buttocks Anatomy and Histology
          Cadaver
          Hip Joint Surgery
      ab: We dissected 20 cadaver hips in order to investigate the anatomy and excursion of the trochanteric muscles in relation to the posterior approach for total hip replacement. String models of each muscle were created and their excursion measured while the femur was moved between its anatomical position and the dislocated position. The position of the hip was determined by computer navigation. In contrast to previous studies which showed a separate insertion of piriformis and obturator internus, our findings indicated that piriformis inserted onto the superior and anterior margins of the greater trochanter through a conjoint tendon with obturator internus, and had connections to gluteus medius posteriorly. Division of these connections allowed lateral mobilisation of gluteus medius with minimal retraction. Analysis of the excursion of these muscles revealed that positioning the thigh for preparation of the femur through this approach elongated piriformis to a maximum of 182%, obturator internus to 185% and obturator externus to 220% of their resting lengths, which are above the thresholds for rupture of these muscles. Our findings suggested that gluteus medius may be protected from overstretching by release of its connection with the conjoint tendon. In addition, failure to detach piriformis or the obturators during a posterior approach for total hip replacement could potentially produce damage to these muscles because of over-stretching, obturator externus being the most vulnerable.
      pubtype: Academic Journal
      doctype: Journal Article
      ougenre: Article
    language: English
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