Superior gluteal nerve - exits greater sciatic notch 25-40mm proximal to tip of greater trochanter, supplies gluteus medius and minimus, injury causes irreversible abductor weakness and Trendelenburg gait - EXAM KEY: stay within 5cm distal to greater trochanter tip (safe zone), never extend split proximally beyond this
Inferior gluteal nerve - enters gluteus maximus 20-30mm inferior to piriformis, injury rare in lateral approach - EXAM KEY: protected by staying anterior to muscle belly
Femoral nerve - lies 40-60mm anterior/medial to surgical field, at risk with over-aggressive anterior retractor placement - EXAM KEY: anterior retractor should stay on bone (ilium/acetabular rim), never slide medially
Sciatic nerve - runs 30-40mm posterior to hip joint, less at risk than posterior approach but can be injured with posterior retractor - EXAM KEY: posterior retractor should stay on ischium/posterior wall, limit retraction time
Lateral femoral cutaneous nerve - runs 50-70mm anterior/superior to incision, generally safe in direct lateral approach - EXAM KEY: incision centered on GT, not extending too far anterior/superior
Profunda femoris artery with medial/lateral femoral circumflex branches - at risk during vastus lateralis mobilization 40-50mm distal to lesser trochanter - EXAM KEY: subperiosteal dissection along vastus ridge protects vessels
Visual Atlas
No anatomy Images Yet
We're currently sourcing high-quality anatomy diagrams for this procedure.
Step-by-Step Technique
1
Posterior approach with extensile options
2
Assess need for extended trochanteric osteotomy
3
ETO: mark 12-15cm length, use oscillating saw
4
Preserve soft tissue attachments to osteotomy fragment
5
Remove cement if present - ultrasonic tools, long carbide drills
6
Serial flexible reamers to establish canal
7
Assess bone stock - Paprosky femoral classification
8
Type I/II: standard primary or proximally porous stem
9
Type IIIA: extensively coated cylindrical stem
10
Type IIIB: modular tapered fluted stem
11
Type IV: consider allograft prosthetic composite or megaprosthesis