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Journal of Orthopaedic Surgery and Research
Published in: Journal of Orthopaedic Surgery and Research 1/2016

Open Access 01-12-2016 | Research article

Distances between bony landmarks and adjacent nerves: anatomical factors that may influence retractor placement in total hip replacement surgery

Authors: Ta-I Wang, Hui-Yi Chen, Chun-Hao Tsai, Horng-Chaung Hsu, Tsung-Li Lin

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2016

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Abstract

Background

Retractor placement is a leading cause of intraoperative nerve injury during total hip replacement (THR) surgery. The sciatic nerve, femoral nerve, and superior gluteal nerve are most commonly affected. This study aimed to identify the distances from bony landmarks in the hip to the adjacent nerves on magnetic resonance imaging (MRI) and the associations between anatomical factors and these distances that would guide the placement of retractors during THR surgery, in order to minimize the risk of nerve injury.

Methods

We reviewed hip MRIs of 263 adults and recorded the distances from (1) the anterior acetabular rim to the femoral nerve; (2) the superior acetabular rim to the superior gluteal nerve; (3) the posterior acetabular rim to the sciatic nerve; and (4) the greater trochanter to the sciatic nerve. The effects of anatomical factors (i.e., gender, age, body height, body mass index (BMI), pelvic width, and acetabular version and morphology) on these distances were analyzed.

Results

Distances from bony landmarks to adjacent nerves (in cm) were 2.06 ± 0.44, 2.23 ± 0.28, 1.94 ± 0.81, and 4.83 ± 0.26 for the anterior acetabular rim, superior acetabular rim, posterior acetabular rim, and greater trochanter, respectively, and were shorter in women than in men (P < 0.001). Multivariate analysis identified body height as the most influential factor (P < 0.001). Linear regression demonstrated a strong positive linear correlation between body height and these distances (Pearson’s r = 0.808, 0.823, 0.818, and 0.792, respectively (P < 0.001)).

Conclusions

The distances from bony landmarks to adjacent nerves provide useful information for placing retractors without causing nerve injury during THR surgery. Shorter patients will have shorter distances from bony landmarks to adjacent nerves, prompting more careful placement of retractors.
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Metadata
Title
Distances between bony landmarks and adjacent nerves: anatomical factors that may influence retractor placement in total hip replacement surgery
Authors
Ta-I Wang
Hui-Yi Chen
Chun-Hao Tsai
Horng-Chaung Hsu
Tsung-Li Lin
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2016
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-016-0365-2

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