Structures At Risk

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The major structure at risk with this approach is the sciatic nerve. It is imperative that this nerve not be damaged. The nerve is fairly far medial. If the approach to the hip joint is through the external rotators along their insertion into the greater trochanter, then the nerve will be protected by those muscles as they are retracted. The nerve is easy to identify because of the loose tissue around it and because it is large and runs longitudinally, whereas all the other structures in the area run transversely.

If the split between the gluteus maximus and medius is carried too far proximally, then the superior gluteal nerve can be damaged. This is the nerve supply to the gluteus medius and minimus, and tensor fascia lata. Damage to the nerve causes significant hip abductor weakness with resultant gait abnormalities.

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