Anterior acetabular retractors and the femoral neurovascular bundle in anterior total hip arthroplasty: a cadaveric study.

Autor: Stubbs T; Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA., Moon AS; Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.; Tufts University School of Medicine, Boston, MA, USA., Dahlgren N; Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA., Patel HA; Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA., Jha AJ; Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA., Shah A; Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA., Naranje SM; Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. sameernaranje@gmail.com.; Birmingham, USA. sameernaranje@gmail.com.
Jazyk: angličtina
Zdroj: European journal of orthopaedic surgery & traumatology : orthopedie traumatologie [Eur J Orthop Surg Traumatol] 2020 May; Vol. 30 (4), pp. 617-620. Date of Electronic Publication: 2019 Dec 20.
DOI: 10.1007/s00590-019-02611-3
Abstrakt: 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.
Databáze: MEDLINE
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