Proximity of the femoral neurovascular bundle during hip resurfacing.
A standard posterior approach was performed in 5 fresh frozen cadaveric limbs. An anterior incision was then used to measure the distance of the femoral neurovascular structures to the anterior capsule. Magnetic resonance imaging (MRI) of 11 hips was also analyzed to validate our cadaveric method. Cadaveric results demonstrated that before dislocation the femoral artery and vein were closest to the anterior capsule (mean distance, 21 mm), and the femoral nerve was the furthest away (mean distance, 25 mm). These results were not significantly different from the MRI findings. When the hip was dislocated, these distances significantly increased. This study suggests that the neurovascular structures are relatively well protected during an anterior capsulotomy performed during hip resurfacing. The procedure may be safer if the capsulotomy is performed with the hip dislocated and in a flexed position while cutting the anterosuperior aspect and in an extended position while cutting the anteroinferior aspect.
The Royal Orthopedic Hospital NHS Foundation Trust, Birmingham, United Kingdom.
Edward T
ET
Davis
Price A
PA
Gallie
Steven L
SL
James
James P
JP
Waddell
Emil H
EH
Schemitsch
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D002102:Cadaver; D005260:Female; D005263:Femoral Artery / Q000033:anatomy & histology; D005267:Femoral Nerve / Q000033:anatomy & histology; D005268:Femoral Vein / Q000033:anatomy & histology; D005269:Femur / Q000033:anatomy & histology / Q000098:blood supply* / Q000294:innervation*; D006621:Hip Joint / Q000033:anatomy & histology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged