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The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve

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Anatomic implications of lesser trochanterplasty.

Onur Hapa¹, Nihat Demirhan Demirkıran¹, Buğra Hüsemoğlu²

¹Department of Orthopedics, Dokuz Eylul University Hospital, Izmir, Turkey.

Acta Orthopaedica Et Traumatologica Turcica

|December 12, 2017

Summary

Lesser trochanter excision up to 15 mm reduces iliopsoas tendon attachment area but does not cause complete detachment. Important nerves and arteries remain safely distant from the surgical site.

Keywords:

Hip arthroscopy Iliopsoas muscle Lesser trochanter

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Area of Science:

Orthopedic surgery
Anatomy
Surgical anatomy

Background:

The lesser trochanter is a critical anatomical landmark in hip surgery.
Understanding the relationship between the lesser trochanter, iliopsoas tendon, and surrounding neurovascular structures is crucial for safe surgical techniques.

Purpose of the Study:

To quantify the iliopsoas tendon attachment area changes after lesser trochanter excision.
To measure the proximity of the sciatic nerve, medial circumflex femoral artery (MCFA), and quadratus muscle to the lesser trochanter tip before and after trochanterplasty.

Main Methods:

Fifteen adult male cadaver hips were analyzed.
Measurements were taken before and after sequential 5, 10, and 15 mm lesser trochanter excisions using a burr.
Distances to the sciatic nerve, MCFA, and quadratus muscle, as well as tendon insertion areas, were recorded.

Main Results:

Progressive bone removal significantly decreased the iliopsoas tendon attachment area (p=0.001).
Mean iliopsoas tendon area reduction was 22% (5 mm), 50% (10 mm), and 76% (15 mm).
The lesser trochanter tip remained at least 20 mm from the sciatic nerve, MCFA, and quadratus tendon.

Conclusions:

Lesser trochanter excision up to 15 mm does not lead to complete iliopsoas tendon detachment.
Surgical procedures involving lesser trochanter modification up to 15 mm appear safe regarding critical adjacent structures.