title: Neurovascular structure proximity to acetabular retractors in total hip arthroplasty.
abstract: Neurovascular injury during total hip arthroplasty (THA) may result in considerable morbidity or mortality. The most common cause of intraoperative neurovascular injury during THA is retractor compression. Our aims were to: 1) determine proximity of common acetabular retractor positions during THA to adjacent neurovascular structures; and 2) determine effect of patient gender on these measurements. Retractor to neurovascular structure distances were measured on 32 preoperative computed tomography images and 16 cadavers. Our data suggest the anterior inferior iliac spine is the safest anterior acetabular retractor position. With inferior progression along the anterior wall, the distance to the femoral neurovascular bundle decreases. Due to its proximity to the sciatic nerve, the position of the posterior retractor should be monitored during acetabular preparation, particularly in women.
authors.affiliation: Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Daniel
authors.initials: D
authors.lastname: Shubert
authors.affiliation: New England Baptist Hospital, Boston, Massachusetts.
authors.forename: Samuel
authors.initials: S
authors.lastname: Madoff
authors.affiliation: North Shore-Long Island Jewish Health Care System, New Hyde Park New York.
authors.forename: Ralph
authors.initials: R
authors.lastname: Milillo
authors.affiliation: Tufts University School of Medicine, Boston, Massachusetts; New England Baptist Hospital, Boston, Massachusetts.
authors.forename: Sumon
authors.initials: S
authors.lastname: Nandi
mesh_terms: D000077:Acetabulum / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation; D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D059348:Peripheral Nerve Injuries / Q000209:etiology* / Q000517:prevention & control; D010525:Peripheral Nerves / Q000000981:diagnostic imaging; D012584:Sciatic Nerve / Q000000981:diagnostic imaging / Q000293:injuries*; D012737:Sex Factors; D014057:Tomography, X-Ray Computed
keywords: acetabulum; hip; neurovascular injury; retractor; total hip arthroplasty