Trevor Stubbs1, Andrew S Moon1,2, Nicholas Dahlgren1, Harshadkumar A Patel1, Aaradhana J Jha1, Ashish Shah1, Sameer M Naranje3,4. 1. Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. 2. Tufts University School of Medicine, Boston, MA, USA. 3. Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. sameernaranje@gmail.com. 4. , Birmingham, USA. sameernaranje@gmail.com.
Abstract
PURPOSE: The direct anterior approach for primary total hip arthroplasty (THA) has become increasingly popular in recent years. Nerve compression or traction with a retractor is a common cause of nerve injury in this approach. The purpose of this cadaveric study was to evaluate the anatomic relationship of the femoral neurovascular bundle to the anterior acetabular retractor during direct anterior approach THA. METHODS: Eleven fresh-frozen cadavers underwent a standard direct anterior THA, with placement of an anterior acetabular retractor in the usual fashion between the iliopsoas and acetabulum for visualization during acetabular preparation. Careful dissection of the femoral triangle was performed, and the distances from the anterior retractor tip to the femoral nerve, artery, and vein were recorded and analyzed as mean distance ± standard deviation. RESULTS: In all 11 cadavers, the retractor tip was medial to the femoral nerve. The mean distance from retractor tip to femoral artery and vein was 5.9 mm (SD = 5.5, range 0-20) and 12.6 mm (SD 0.7, range 0-35), respectively. CONCLUSIONS: Surgeons should be aware of the proximity of the neurovascular structures in relation to the anterior acetabular retractor in the direct anterior approach, taking care to avoid perforating the iliopsoas muscle during retractor insertion and limit excessive traction to prevent nerve injury.
PURPOSE: The direct anterior approach for primary total hip arthroplasty (THA) has become increasingly popular in recent years. Nerve compression or traction with a retractor is a common cause of nerve injury in this approach. The purpose of this cadaveric study was to evaluate the anatomic relationship of the femoral neurovascular bundle to the anterior acetabular retractor during direct anterior approach THA. METHODS: Eleven fresh-frozen cadavers underwent a standard direct anterior THA, with placement of an anterior acetabular retractor in the usual fashion between the iliopsoas and acetabulum for visualization during acetabular preparation. Careful dissection of the femoral triangle was performed, and the distances from the anterior retractor tip to the femoral nerve, artery, and vein were recorded and analyzed as mean distance ± standard deviation. RESULTS: In all 11 cadavers, the retractor tip was medial to the femoral nerve. The mean distance from retractor tip to femoral artery and vein was 5.9 mm (SD = 5.5, range 0-20) and 12.6 mm (SD 0.7, range 0-35), respectively. CONCLUSIONS: Surgeons should be aware of the proximity of the neurovascular structures in relation to the anterior acetabular retractor in the direct anterior approach, taking care to avoid perforating the iliopsoas muscle during retractor insertion and limit excessive traction to prevent nerve injury.
Entities:
Keywords:
Acetabular retractors; Anterior approach; Arthroplasty; Cadaver; Femoral neurovascular bundle; Total hip
Authors: Eric M Cohen; Joshua J Vaughn; Scott A Ritterman; Daniel L Eisenson; Lee E Rubin Journal: J Arthroplasty Date: 2017-04-21 Impact factor: 4.757
Authors: George A Macheras; Panayiotis Christofilopoulos; Panagiotis Lepetsos; Andreas O Leonidou; Panagiotis P Anastasopoulos; Spyridon P Galanakos Journal: Hip Int Date: 2016-04-13 Impact factor: 2.135