The gluteal sling: an anatomical study

Sciatic nerve palsy is a devastating complication which may be seen after acetabular exposure in total hip resurfacing via a posterior approach. An anatomical structure termed as the “gluteal sling” was suggested to play a role in sciatic nerve palsies during this operation. “Gluteal sling” is formed by the attachment of the deep fibers of the inferior part of the gluteus maximus on the gluteal tuberosity of the femur and the lateral intermuscular septum. It is suggested to be released to avoid such compressive injuries. The purpose of this study is to demonstrate how much of the gluteal sling should be released to decrease the tension on sciatic nerve during posterior hip arthroplasties. We also aimed to study the anatomical structures at risk during releasing procedure.

The gluteal sling was examined in 17 sides of 9 adult cadavers. Its relation with the sciatic nerve, first perforating artery, the tip of greater trochanter and the ischial tuberosity were evaluated.

The closest distance between the gluteal sling and the sciatic nerve was measured as 1.9 ± 0.6 cm. This point was corresponding to the distal 2/3 part of the gluteal sling. The distance of the proximal edge of the gluteal sling to the first perforating artery was 3.7 ± 0.9 cm, while its ascending branch was closer, being 1.8 ± 0.8 cm.

Theoretically, it is enough to release the proximal 2/3 of the gluteal sling to avoid its compression on the sciatic nerve. However, further clinical studies would need to be undertaken to properly determine the effects of this procedure.