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European Journal of Orthopaedic Surgery & Traumatology

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01-05-2020 | Nerve Injury | Original Article

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

Authors: Trevor Stubbs, Andrew S. Moon, Nicholas Dahlgren, Harshadkumar A. Patel, Aaradhana J. Jha, Ashish Shah, Sameer M. Naranje

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 4/2020

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.

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Title: Anterior acetabular retractors and the femoral neurovascular bundle in anterior total hip arthroplasty: a cadaveric study
Authors: Trevor Stubbs
Andrew S. Moon
Nicholas Dahlgren
Harshadkumar A. Patel
Aaradhana J. Jha
Ashish Shah
Sameer M. Naranje
Publication date: 01-05-2020
Publisher: Springer Paris
Keywords: Nerve Injury
Hip-TEP
Hip-TEP
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 4/2020
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-019-02611-3

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Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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