The purpose of this study was to evaluate the incidence of intraoperative superior gluteal nerve irritation and to identify specific surgical maneuvers that may harm the nerve. Continuous intraoperative electromyography (EMG) monitoring of the superior gluteal nerve-innervated muscles (gluteus medius and tensor fascia lata muscles) was performed in 12 patients undergoing total hip arthroplasty. A modified lateral approach was used, including a partial anterior osteotomy of the greater trochanter with splitting of the gluteus medius and vastus lateralis muscles. All patients had a clinical follow-up examination 1 year postoperatively to evaluate abductor muscle function. Irritation of the nerve occurred first during splitting of the gluteus medius muscle, then with increased gluteus medius retraction for exposure of the acetabulum, and finally during positioning of the leg for preparation of the femur. The detected EMG alterations were important because they were found in a single patient with persistent abductor muscle weakness.