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Piriformis and obturator internus morphology: a cadaveric study.

James Pine1, Malcolm Binns, Phil Wright

  • 1St. James's University Hospital, Leeds Teaching Hospitals Trust, Beckett St, Leeds, United Kingdom.

Clinical Anatomy (New York, N.Y.)
|December 15, 2010
PubMed
Summary

Preserving the piriformis tendon during hip surgery may reduce dislocation risk. Anatomical study of piriformis and obturator internus tendons reveals their insertion points, informing surgical approaches for better hip joint preservation.

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Area of Science:

  • Orthopedic Surgery
  • Human Anatomy
  • Biomechanical Engineering

Background:

  • Posterior approaches to the hip joint in total hip arthroplasty (THA) can risk dislocation.
  • Preserving the piriformis tendon during these procedures may lower dislocation rates.

Purpose of the Study:

  • To investigate anatomical variations of the piriformis and obturator internus tendons.
  • To inform the development of piriformis-sparing surgical approaches for THA.

Main Methods:

  • Dissection and measurement of 29 proximal femora from 15 cadavers (5 male, 10 female; aged 65-79).
  • Analysis of tendon crossing angles, insertion sites on the greater trochanter, and tendon fusion.
  • Quantification of piriformis and obturator internus tendon dimensions and their relative positions to the greater trochanter.

Main Results:

  • Mean vertical and horizontal widths of piriformis tendons were 4.78 ± 1.31 mm and 7.35 ± 1.74 mm.
  • Mean vertical and horizontal widths of obturator internus tendons were 6.87 ± 1.61 mm and 5.72 ± 1.38 mm.
  • Posterior margins of both tendons insert more than one-third along the greater trochanter, suggesting current osteotomies may not affect them.

Conclusions:

  • Identified four classifications based on piriformis and obturator internus tendon relationships.
  • Findings suggest that typical osteotomies in posterior hip approaches may spare the piriformis and obturator internus tendons.
  • This anatomical knowledge can guide the refinement of piriformis-sparing surgical techniques in THA.