THR: Identification and Protection of Sciatic Nerve 

- See: Neurologic Injuries in THR:

- Discussion:
    - sciatic nerve is palpated by rolling it under surgeon's finger as it crosses ischial projection from posteroinferior aspect of the acetabulum;
    - palpate sciatic nerve as it passes superficial to obturator internus & gemelli;
           - sciatic nerve emerges below piriformis & passes downwards superficial to obturator internus & gemelli & quadratus femoris;
    - if possible, sciatic nerve should be reidentified every time hip is moved;
    - it is not always necessary to identify sciatic nerve, unless hip joint is grossly distorted;
         - in fact, dissection to see nerve may cause unnecessary bleeding from the vessels lying in the fat around it;
    - sciatic nerve sometimes divides into a tibial and peroneal brach within pelvis, and on occassion one may identify the sciatic nerve but think that it looks to small, then search for the other branch



Use of multimodal intra-operative monitoring in averting nerve injury during complex hip surgery.

Sciatic nerve localization relative to the position of the hip, an anatomical study

Intraneural sciatic nerve pressures relative to the position of the hip and knee: a human cadaveric study.

Strain on the human sciatic nerve in vivo during movement of the hip and knee

Exposure of the sciatic nerve in the gluteal region without sectioning the gluteus maximus: Analysis of a series of 18 cases.

Sciatic nerve palsy after primary total hip arthroplasty: a new perspective.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, April 9, 2012 1:48 pm