Top

Journal of Orthopaedic Surgery and Research

Published in:

Open Access 01-12-2018 | Research article

The distance of the femoral neurovascular bundle from the hip joint: an intraoperative guide to reduce iatrogenic injury

Authors: Cyrus R. Mehta, Alex Constantinidis, Moussa Farhat, Mayuran Suthersan, Edward Graham, Andrew Kanawati

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2018

Abstract

Background

Iatrogenic injury to the femoral neurovascular bundle is not uncommon during primary and revision total hip replacement (THR) and can result in permanent weakness, pain and poor function. Prevention of injury to these structures relies on a sound knowledge of their relationships to the hip joint.

Methods

We studied 115 consecutive hip magnetic resonance imaging (MRI) results in order to identify objective relationships between these structures and the hip joint that can be used intraoperatively.

Results

We determined that the shortest mean distances of the femoral nerve, artery and vein from the hip joint are 23.62 (standard deviation, SD = 5.44), 19.62 (SD = 4.17) and 17.47 (SD = 4.41) mm, respectively. The femoral nerve was lateral to the hip joint in 30 (55.5%) left- and 37 (60.7%) right-sided hip joints. The femoral artery was located medial to the hip joint in 28 (51.9%) left- and 34 (55.7%) right-sided hips. The femoral vein was medial to the hip joint in 52 (96.3%) left- and 58 (95.1%) right-sided hips.

Conclusion

We have identified objective relationships between the hip joint and femoral neurovascular bundle that can be used with ease intraoperatively during THR. Our data show that patients with a low body weight and the elderly may be at a higher risk of iatrogenic injury due to increased proximity of the neurovascular structures to the hip. Application of this knowledge may serve to reduce the risk of iatrogenic injury to these structures and thereby improve patient satisfaction and outcomes.

Kretschmer T, Heinen CW, Antoniadis G, Richter H, König RW. Iatrogenic nerve injuries. Neurosurg Clin N Am. 2009;20(1):73–90. https://doi.org/10.1016/j.nec.2008.07.025.CrossRefPubMed

Farrell CM, Springer BD, Haidukewych GJ, Morrey BF. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg. 2005;87-A:2619–25.CrossRef

Weale AE, Newman P, Ferguson IT, Bannister GC. Nerve injury after posterior and direct lateral approaches for hip replacement. A clinical and electrophysiological study J Bone Joint Surg. 1996;78-B:899–902.CrossRef

Navarro RA, Schmalzried TP, Amstutz HC, Dorey FJ. Surgical approach and nerve palsy in total hip arthroplasty. J Arthroplast. 1995;10:1–5.CrossRef

Simmons C Jr, Izant TH, Rothman RH, et al. Femoral neuropathy following total hip arthroplasty. Anatomic study, case reports, and literature review. J Arthroplasty. 1991;6(6 Suppl):S57–66.

Schmalzried TP, Amstutz HC, Dorey FJ. Nerve palsy associated with total hip replacement. Risk factors and prognosis. J Bone Joint Surg. 1991;73-A:1074–80.CrossRef

McConaghle FA, Payne AP, Kinninmonth AWG. The role of retraction in direct nerve injury in total hip replacement. Bone Joint Res. 2014;3:212–6.CrossRef

Fox AJ, Bedi A, Wanivenhaus F, Sculco TP. Femoral neuropathy following total hip arthroplasty review and management guidelines. Acta Orthop Belg. 2012;78:145–51.PubMed

Segal, D., Yaacobi, E., Marom, N., Feldman, V., Aliev, E., Palmanovich, E.,. .. Brin, Y. S. (2017). The incidence of life threatening iatrogenic vessel injury following closed or open reduction and internal fixation of intertrochanteric femoral factures. Int Orthop,41(9), 1845–1850. https://doi.org/10.1007/s00264-017-3545-8.CrossRefPubMed

10.

Riouallon G, Zilber S, Allain J. Common femoral artery intimal injury following total hip replacement. A case report and literature review. Orthopaedics & Traumatology: Surgery & Research. 2009;95(2):154–8. https://doi.org/10.1016/j.otsr.2008.11.002.CrossRef

11.

Johanson NA, Pellicci PM, Tsairis P, Salvati EA. Nerve injury in total hip arthroplasty. Clin Orthop Relat Res. 1983;179:214–22.CrossRef

12.

Schmalzried TP, Amstutz HC, Dorey FJ. Nerve palsy associated with total hip replacement: risk factors and prognosis. J Bone Joint Surg [Am]. 1991;73-A:1074.CrossRef

13.

Ward R. Hip joint. Bergmans comprehensive encyclopedia of human anatomic variation; 2016. p. 176–80. https://doi.org/10.1002/9781118430309.ch19.CrossRef

14.

Shubert D, Madoff S, Milillo R, Nandi S. Neurovascular structure proximity to acetabular retractors in total hip arthroplasty. J Arthroplast. 2015;30(1):145–8. https://doi.org/10.1016/j.arth.2014.08.024.CrossRef

15.

Wang T, Chen H, Tsai C, Hsu H, Lin T. Distances between bony landmarks and adjacent nerves: anatomical factors that may influence retractor placement in total hip replacement surgery. J Orthop Surg Res. 2016;11(1) https://doi.org/10.1186/s13018-016-0365-2.

16.

Neurovascular Anatomy in Interventional Neuroradiology. (2015). Neurovascular Anatomy in Interventional Neuroradiology. https://doi.org/10.1055/b-0035-129450.

17.

Hoppenfeld S, Boer PD, Buckley R. Surgical exposures in orthopaedics: the anatomic approach. Philadelphia: Wolters Kluwer; 2017.

18.

Yacub J, Bradford Rice J, Dillingham T. Nerve injury in patients following hip and knee arthroplasties and knee arthroscopy. Am J Phys Med Rehabil. 2009;88(8):635–91. https://doi.org/10.1097/PHM.0b013e3181ae0c9d.CrossRefPubMedPubMedCentral

19.

Starks I, Wainwright T, Middleton R. Local anaesthetic infiltration in joint replacement surgery: what is its role in enhanced recovery? International Scholarly Research Notices Anaesthesiology. 2011; https://doi.org/10.5402/2011/742927.

Title: The distance of the femoral neurovascular bundle from the hip joint: an intraoperative guide to reduce iatrogenic injury
Authors: Cyrus R. Mehta
Alex Constantinidis
Moussa Farhat
Mayuran Suthersan
Edward Graham
Andrew Kanawati
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2018
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-018-0847-5

At a glance: The STEP trials

Springer Medicine

The distance of the femoral neurovascular bundle from the hip joint: an intraoperative guide to reduce iatrogenic injury

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2018

A novel ultrasound scanning approach for evaluating femoral cartilage defects of the knee: comparison with routine magnetic resonance imaging

Primary total knee arthroplasty using constrained condylar knee design for severe deformity and stiffness of knee secondary to post-traumatic arthritis

Normal radiological anatomy of thyroid cartilage in 600 Chinese individuals: implications for anterior cervical spine surgery

Bioinformatics analysis of differentially expressed genes in rotator cuff tear patients using microarray data

Clinical outcomes of femoral shaft non-union: dual plating versus exchange nailing with augmentation plating

RETRACTED ARTICLE: Comparison of two FDA-approved interspinous spacers for treatment of lumbar spinal stenosis: Superion versus X-STOP—a meta-analysis from five randomized controlled trial studies