Anterior acetabular retractors and the femoral neurovascular bundle in anterior total hip arthroplasty: a cadaveric study
| Autor: | Sameer Naranje, Trevor Stubbs, Aaradhana J. Jha, Ashish Shah, Nicholas Dahlgren, Andrew S. Moon, Harshadkumar A Patel |
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| Rok vydání: | 2019 |
| Předmět: |
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Anatomic Iliopsoas Muscle Arthroplasty Replacement Hip Femoral artery 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Femoral nerve Peripheral Nerve Injuries Traction medicine.artery Cadaver medicine Humans Orthopedics and Sports Medicine Intraoperative Complications 030222 orthopedics business.industry Acetabulum Anatomy Femoral Vein Vascular System Injuries Surgical Instruments musculoskeletal system Neurovascular bundle Femoral Artery Retractor surgical procedures operative medicine.anatomical_structure Femoral triangle Surgery Iliopsoas Cadaveric spasm business Femoral Nerve |
| Zdroj: | European Journal of Orthopaedic Surgery & Traumatology. 30:617-620 |
| ISSN: | 1432-1068 1633-8065 |
| Popis: | 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. 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. 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. 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: | OpenAIRE |
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